Epilepsy syndromes affect 3 percent of the population, about 80 million worldwide. The treatment of epilepsy has focused on behavior, medications and surgery. Last week the RNS stimulator became the first FDA-approved implant for epilepsy. For the approximately 30 percent who have inadequate seizure control with traditional approaches to treatment, this may be a life-changer. Epilepsy, what do you know, T or F?
1. It is a single brain disease.
2. Surgery is the main treatment.
3. Demons were thought to be a cause.
Epilepsy occurs in about 2.3 million adults and over 450,000 children in the United States. Many famous people have epilepsy. Bud Abbott of the iconic comedy duo Abbott and Costello had epilepsy starting in childhood. Actor Danny Glover has epilepsy, as do singers Lil Wayne, Susan Boyle and Prince. When Shakespeare wrote about the “falling sickness” in “Julius Caesar” he was describing the emperor's epilepsy, a condition which he quite likely had but is not confirmed.
Epilepsy has been grossly misunderstood and therefore those afflicted mischaracterized. Those with epilepsy suffered doubly from the disease itself and from personal condemnation. They were often shunned or miscast as being evil.
Historically there has often been an attempt to associate epilepsy with religious or demonic activity. The famed anatomist and surgeon Galen observed incorrectly, in second century AD, that epilepsy was associated with the moon phases of the lunar cycle. Thereafter, epileptics were referred to as lunatics.
Centuries earlier the writings and influence of Hippocrates on the subject of epilepsy is found in “On The Sacred Disease” a text written in 400 BCE. The author writes that epilepsy is not any more “sacred” than any other disease and has a natural (not supernatural) cause. Finding the cause, Hippocrates and his followers wrote, would demystify epilepsy and stop the irrational association with gods and demons. As usual, Hippocrates was right.
Epilepsy is not a single disorder but rather a group of neurologic disorders characterized by recurrent seizures. Epilepsy can be present in any age. The cause or specific diagnosis may or may not ever be known. Medications are prescribed to help control the frequency and duration of seizures.
Some epilepsy syndromes are more effectively managed than others. For some, medicines are very successful. For others, surgery may provide some relief. Still, it is estimated that up to 30 percent fail usual treatments and have difficulty controlling their seizures. For those, the newly approved RNS stimulator may offer hope.
The RNS stimulator is the first FDA-approved implant for epilepsy. The device is made by NeuroPace, an American company, and is projected to cost between $35,000 and $40,000. It is surgically implanted in the skull and monitors brain activity.
The battery-operated RNS stimulator senses abnormal neuron activity. Once detected, it sends tiny electric pulses to interrupt the aberrant electrical firing and prevent a full-blown seizure from erupting. Two years after the implants more than 50 percent of research subjects reported a 50-percent reduction in number of seizures. This is a remarkable advance in the treatment of epilepsy.
The RNS stimulator is approved for those with partial type seizures, who are at least 18 years of age and who have failed two or more medications. Specific qualifications for the use of the device can be gained through discussion with the treating neurologist.
Scientists caution that this is not a cure. For the millions with partial type seizures the RNS stimulator may offer tremendous improvements in quality of life. It is not in the stars, or the moons or the gods or the devils. Hippocrates was right.
Answers: 1. F 2. F 3. T
Dr. Lori Boyajian-O’Neill can be contacted at firstname.lastname@example.org.