Feature Story | 9-Feb-2023

Mayo Clinic neurosurgeon describes the latest options for treating epilepsy

International Epilepsy Day is February 13

Mayo Clinic

ROCHESTER, Minnesota — Epilepsy is a neurological disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy and epilepsy affects males and females of all races, ethnic backgrounds and ages. In this expert alert, Jamie Van Gompel, M.D., a neurosurgeon at Mayo Clinic, describes the latest treatment options.  

"The range of potential treatments is much broader now," Dr. Van Gompel says. "We have really improved the outcomes for patients. I think it is important to explore treatment options because they can have substantial, meaningful impacts on patients’ lives." 

Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. 

Medications for epilepsy have improved and remain the most common way to treat epilepsy:  Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy, Dr. Van Gompel says.  

Open surgery to remove the portion of the brain that's causing the seizures is still an important treatment option for epilepsy that isn't controlled by medication. In recent years, new treatment options for epilepsy, including minimally invasive options, have developed.  

The latest treatments include: 

  • Deep brain stimulation. This is the use of a device that is placed permanently deep inside the brain. The device releases regularly timed electrical signals that disrupt seizure-inducing activity. This procedure is guided by MRI. The generator that sends the electrical pulse is implanted in the chest. 

  • Responsive neurostimulation. These implantable, pacemaker-like devices can help significantly reduce how often seizures occur. These responsive stimulation devices analyze brain activity patterns to detect seizures as they start and deliver an electrical charge or drug to stop the seizure before it causes impairment. Research shows that this therapy has few side effects and can provide long-term seizure relief. This device is placed in the skull.  

  • Laser interstitial thermal therapy (LITT). This is less invasive than resective surgery. It uses a laser to pinpoint and destroy a small portion of brain tissue. An MRI is used to guide the laser. 

  • Minimally invasive surgery. New minimally invasive surgical techniques, such as MRI-guided focused ultrasound, show promise at treating seizures with fewer risks than traditional open brain surgery for epilepsy. 

Dr. Van Gompel encourages people with epilepsy to check in with their primary care provider or neurologist about their current treatment, and not to hesitate to seek a second opinion at an epilepsy center, especially if they are having medication-related side effects or are continuing to have seizures. 

“If you haven’t seen a specialist in the last five years, you should see an epileptologist at a specialized care center,” Dr. Van Gompel says. "Epilepsy treatments are changing so rapidly right now that there might be something new that can help." 

Research in the field continues to focus on seizure prevention; prediction, also known as seizure forecasting; and treatment. Dr. Van Gompel predicts that the use of artificial intelligence and machine learning will help neurologists and neurosurgeons continue to improve treatment options and outcomes. 

"I think we will continue to move more and more toward removing less and less brain tissue," Dr. Van Gompel says. "I believe that in future decades, we will understand brain stimulation enough that maybe we'll never remove brain tissue again. Maybe we'll be able to treat that misbehaving brain with electricity or something else. Maybe sometimes it's drug delivery, directly into the area, which will rehabilitate that area to make it functional cortex again. That is our hope." 


About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact: Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu 

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