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Published on March 01, 2018

Neurologists Gain Ground on Epilepsy Treatment Options

Implant located under patient's scalpThe RNS System’s small neurostimulator is implanted
under the patient’s scalp and connects to leads placed
in two seizure onset areas in the brain.

Patients with epilepsy rely on neurologists at North Kansas City Hospital for expert treatment. Although there is no cure for epilepsy, the breadth of treatment options continues to expand. Newer medications, imaging that pinpoints abnormalities for brain resections, and implantable devices that monitor and respond to brain activity are three such advancements in the evaluation and treatment of epilepsy patients.

“My epilepsy colleagues and I are in agreement that these patients can be profoundly limited by their condition, and so it is vital for physicians to be aggressive in making the goal seizure freedom,” said Sarah J. Hon, DO, FAAN, a neurologist with Meritas Health Neurology. “Even going from four seizures a month to four a year means a patient still doesn’t have a driver’s license, may not be able to hold down a job, has an unpredictable life, and can have significant injuries and even risk of sudden death.”

Specialized Care

Epilepsy Definition

In 2014, the International League Against Epilepsy redefined epilepsy as a brain disease with any of the following:

  • At least two unprovoked (or reflex) seizures occurring more than 24 hours apart
  • One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
  • Diagnosis of an epilepsy syndrome

Epilepsy is considered to be resolved for individuals past the applicable age of an age-dependent epilepsy syndrome or those who have remained seizure-free for the past 10 years, with no seizure medicines for the past five years.

One in 26 people will develop epilepsy at some point in their lifetime. Despite the development of a number of new medications for patients with epilepsy, up to one-third of those individuals will not respond adequately to medications. “If a patient has not become seizure-free despite the trial of two seizure medications appropriate for their type of epilepsy, the American Academy of Neurology, along with the American Epilepsy Society, recommends they be referred to a physician with expertise in epilepsy treatment,” said Dr. Hon, who is board certified in both neurology and epilepsy.

Patients are often delayed in receiving high-level epilepsy care. “They try medication after medication and combinations of medications before being evaluated by a neurologist with epilepsy expertise,” said Dr. Hon. Presently, Dr. Hon, along with her epilepsy colleagues, is leading the formation of the Kansas City Epilepsy Society.

Precise Imaging

The detailed imaging of the hospital’s 3T MRI machine acquired last spring provides accurate neurological function to guide brain resection. The 3T seizure protocol provides additional sequences for anatomical abnormalities that can trigger epilepsy. “The 3T helps us identify these abnormalities earlier because many patients do not respond to medicines, but may be amenable to surgery,” Dr. Hon said.

Brain resection may be an alternative for some patients whose seizures cannot be adequately controlled with medications. “We estimate that between 60%-80% of patients with right mesial temporal sclerosis, one of the most common abnormalities that causes difficult-to-control seizures, may become seizure-free after brain resection,” Dr. Hon said. “Many of these patients have been on medications for years and continue to seize.”

Implantable Devices

RNS Sysyem deviceThe RNS System monitors and responds to brain
activity much like how a pacemaker responds to
heart rhythms.

Implantable devices that detect and prevent seizures may be an alternative for some patients who are resistant to medications and not eligible for brain resection. Dr. Hon pointed to two – the RNS® System and SenTivaTM. Dr. Hon programs the devices to each individual, and she can review the data collected for any needed treatment adjustments.

The RNS System’s small neurostimulator is implanted under the patient’s scalp and connects to leads placed in two seizure onset areas in the brain. It monitors and responds to brain activity much like how a pacemaker responds to heart rhythms. When abnormal activity is detected, the neurostimulator sends undetectable electrical pulses to disrupt the activity so the individual does not experience a seizure.

The size of a pocket watch, the newly-released SenTiva is implanted beneath the collar bone. Wires connected from the device to the vagus nerve send mild electrical impulses at regular intervals 24/7 to reduce and lessen the duration of seizures. A wireless wand and tablet interface control the device’s generator, allowing patients to make adjustments. For example, when a patient feels a seizure coming on, he or she can activate the mild electrical impulses by holding a small magnet over the implanted device.

Sarah J. Hon, DO, FAAN

Sarah J. Hon, DODr. Hon earned her medical degree from Kansas City University of medicine and Biosciences. She completed her residency in neurology at the University of Kansas School of Medicine, Kansas City.

In addition to her busy practice, Dr. Hon also spends time advocating for patients on behalf of the American Academy of Neurology. In fact, in February 2018, she was one of six Missouri neurologists selected to Neurology on the Hill, an American Academy of Neurology conference where neurologists also met with members of Congress. During the event, she met with federal lawmakers to request support for neurologic research and programs that improve patient care.