Better tools & treatments emerging for Epilepsy
November is Epilepsy Awareness month. Neurotechnologies are emerging to improve diagnoses and treatments for people living with epilepsy. Here we highlight some of the available modalities and what is in the pipeline of development.
Epilepsies are a spectrum of brain disorders ranging in severity. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior. This change in neuronal activity can also cause convulsions, muscle spasms, and loss of consciousness. Epilepsies also accompany several types of seizures. Anything that disturbs the normal pattern of neuron activity from illness to brain damage to abnormal brain development can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, changes in important features of brain cells called channels, or some combination of these and other factors. Having a single seizure as the result of a high fever (called febrile seizure) or head injury does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures are they considered to have epilepsy.
Epilepsy afflicts 2.5 million people in the U.S. and 50 million worldwide. It is characterized by the occurrence of spontaneous seizures. For many people living with epilepsy, anticonvulsant medications can be given at sufficiently high doses to prevent seizures, but there are several side effects. For 20 to 40 percent of people living with epilepsy, medications are not effective. In some cases, even after surgical removal of epilepsy-causing brain tissue, many people continue to experience spontaneous seizures. Despite the fact that seizures occur infrequently, people living with epilepsy experience persistent anxiety due to the possibility of a seizure occurring.
Epilepsy often is undiagnosed in the elderly. While many people think of epilepsy as a disease of children and young people, new onset epilepsy is actually more common in adults over the age of 65. Stroke is the leading cause of epilepsy among older people. Epilepsy can also be a result of a brain injury. In many instances, epilepsy may not be diagnosed until it has developed into recognizable seizure activity.
Neurotechnology devices have been and are currently being developed not just for the treatment of epilepsy but also as a diagnostic tool too. Vagus nerve stimulation, cortical stimulation as well as trigeminal nerve stimulation have all been developed to help people to manage their conditions. Also technologies such as EEG, MEG and ECoG are tools to improve the diagnosis of the condition.
Technologies of today
Typically a person who may be suspect for epilepsy is asked to keep a seizure diary for self-reporting purposes. This may help but people tend to report less than 50% of their own seizures, according to a 2018 published paper in Lancet Neurology. Objective and quantitative data collection tools are a means to identify even a mild seizure. The latest in technology has improved for diagnosis and monitoring of seizure activity. EEG devices can be used in the clinic but now we are seeing mobile EEG monitoring devices. These mobile devices allow the person to wear the device while going about daily activities. The device captures the information to allow for a data-driven diagnosis.
Available treatments have emerged for treating epilepsy for the management of seizures. Many of the U.S. FDA approved devices are available for those living with “treatment resistant” or “refractory” epilepsy. Still the array of available devices is exciting. Vagus nerve stimulation has been approved for use since the 1990s. It consists of a surgically implanted electrode onto the vagus nerve in the neck and a pulse generator (IPG) in the upper chest. The device delivers electrical stimulation to suppress a seizure. More recently, the responsive neurostimuation system has emerged as an alternative to VNS. This device is surgically implanted into the brain. It provides both sensing and stimulating therapy so it can detect a potential seizure and then stimulates to suppress it. One other surgical modality is deep brain stimulation. Again this requires a surgical procedure to implant an electrode deep into the brain with an IPG into the chest area. The Neurotech Network directory has a listing of these devices and how to learn more about them.
Technologies under development
While many of the approved neurotechnology treatments for epilepsy require a surgically implanted device, there is an array of non-invasive or external devices under development. Repetitive transcranial magnetic stimulation is one such device. It is currently approved for the treatment of depression and pain management. At this time, rTMS treatments are a clinical treatment modality and not a home-use device. On the other hand, non-invasive vagus nerve stimulation is under investigation. These devices stimulate the vagus nerve much like the implanted device but the treatment is delivered through the surface of the skin. One other non-invasive device modality is trigeminal nerve stimulation. It takes the form of a surface electrode placed on the forehead region. Both nVNS and eTNS are FDA approved for migraine and cluster headaches. Finally, a new and emerging technology is optoelectronics. This involves a combination of light and electrical stimulation to provide a treatment for epilepsy. This is still in early development.
The Epilepsy Foundation provides a wonderful explanation of the various devices described here: https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices
Resources
To learn more about both available and emerging neurotechnologies for Epilepsy and Seizure Management, visit our resource directory. You will find a listing of some of the devices mentioned here and more.
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