Do you know? “Epilepsy” brain disease can be cured permanently

Epilepsy … is not just a syndrome but consists of symptoms or a brain disease that results in unstimulated seizures. High fever is one of the stimulators for seizures, which often occur more than two times in life. Some patients or individuals who experience epilepsy may not be aware of the symptoms and pathology until they get severe. This phenomenon of epilepsy is sometimes called the volcano effect, where an active volcano can erupt any time. But do you know? Epilepsy can actually be cured permanently! Therefore, the sooner the pathology is diagnosed, the higher the chance that a patient can return to their joyful daily life will be.

“Epilepsy” or not? Verify it with EEG

Electroencephalography or EEG records

An electroencephalogram (EEG) detects electrical activity in the brain, which passes through the scalp via a number of electrodes. EEG reports the electrical activity as wavy lines of different frequency and shapes on a printed paper or a screen of a monitor. These results are then interpreted as normal or abnormal, along with type and area of the brain where abnormality is found. This brain wave recording process occurs under a number of conditions, such as when a patient is awake, sleeping, during a seizure, or being stimulated with light, etc. Therefore, EEG provides an accurate diagnosis of epilepsy. It benefits a doctor in verifying the syndrome type and choosing a treatment method and medication that are suitable for each patient.

Patient preparation before EEG procedure

• Thoroughly wash hair. Shampoo, conditioner, oil, cream, spray, and mousse are not recommended.
• Take antiepileptic drugs as usually. Do not stop taking them before undergoing EEG diagnosis unless advised by a doctor.
• In the case of a small child, a sleeping pill may be taken prior to the examination. A parent should prepare bottles of milk, water, and toys.

The EEG process

1. Electrodes are attached to different locations on the scalp and then connected to the EEG machine.
2. Once the EEG machine is on, the lines showing electrical activity in the brain appear on the screen at all times and are recorded for further interpretation for approximately 30 minutes – 1 hour, depending on each case.
3. Different activation procedures are performed to provoke brain wave activity, including hyperventilation (deep breathing) for consecutive 3-5 minutes, using a flashing lights to a patient’s face (photic stimulation).

*In the case of small children or children with developmental problems who are uncooperative, a sleeping pill may be taken. However, they must later on be awake while being diagnosed.

Patient evaluation criteria… for epilepsy surgery treatment

The available statistics show that approximately 75% of epilepsy patients can take medications to achieve seizure control. However, there are around 20-30% of patients who still experience seizures despite taking appropriate medication; and 5-10% of them are medically intractable. This group of patients may need to consider undergoing surgery. Patient evaluation criteria for epilepsy surgery treatment differ from general brain surgery as follows.

1. A patient must be confirmed to have drug resistant epilepsy.
2. 24-hour video EEG monitoring is operated to identify where seizures begin.
3. Undergo MRI Epilepsy Protocol
4. Undergo neuropsychological testing (memory evaluation of 2 brain sides)
5. Some patients may require functional imaging inspection, such as PET scan, SPECT.
6. The decision whether each patient should undergo the surgery should be made by epileptologists, neurologists, and surgeons.

Epilepsy surgery can be categorized into 2 primary types as follows.

1. Resective epilepsy surgery is considered when a patient’s epileptogenic focus (the source of seizures) is localized; and the surgery will not cause malfunctions of the body or worsen the disability. These patients often experience epilepsy as a result of hippocampal sclerosis, tumor, cavernoma, AVM, cortical dysplasia, and Rasmussen’s encephalitis.
2. Neuromodulatory epilepsy surgery is considered when there are multiple sources of seizures in both sides of the brain; or when an epileptogenic focus is located in a functionally critical brain area that cannot be removed. This type of surgery, which includes corpus callosotomy or vagus nerve stimulation, cannot permanently stop seizures but aims to achieve seizure frequency reduction and their associated risks.

If the preoperative evaluation data is well consistent, a patient has a high chance of becoming seizure free. In some cases, although not all data is well consistent, the surgery is still beneficial to the patient. Despite the reduced opportunity of being seizure free, the frequency of seizures is decreased. Current medical advances also result in low risk from epilepsy surgery treatment.