What is the best therapy?
Most epileptics use medicines, the so-called anti-epileptics. Kempenhaeghe has quite a body of knowledge about medicines and their adverse effects. Unfortunately, not all patients can be helped with (a combination of) medicines. In such cases, Kempenhaeghe will asses what treatment options might be successful. Kempenhaeghe collaborates closely with academic hospitals in this approach.Treatment methods for epilepsy
Medicines: anti-epileptics
Brain surgery: epilepsy surgery
Epilepsy surgery, a brain operation, intends to make patients seizure-free. Patients are eligible for epilepsy surgery if:
- Their seizures persist, seriously affecting their lives, despite the use of medication
- Their seizures originate in one area of their brain
- This area – the epileptic focus – can be surgically removed without inflicting significant damage such as paralysis and loss of speech or memory
So, the possible advantage of the operation should outweigh the risks.
The brain operation is performed in an academic hospital. Kempenhaeghe plays an essential role in selecting and preparing patients for epilepsy surgery and in their aftercare. Kempenhaeghe performs examinations, such as seizure recording (EEG recording with video monitoring), MRI and neuropsychological tests, to asses if surgery is a treatment option. The benefits, disadvantages and risks of the operation are extensively discussed with the patient.
Annually, approximately 70 patients have brain surgery in the Netherlands. Kempenhaeghe performs scientific research concerning the approach and effects of epilepsy surgery.
Ketogenic diet
A ketogenic diet is utilized in:
- (Young) children with a complex form of epilepsy
- Who cannot be treated with medication
- And who are not eligible for epilepsy surgery
The diet consists of fat enriched food with few carbohydrates and a regular quantity of proteins. The body misses the carbohydrates and will find an alternative source of energy. It switches over to burning fat, which results in the release of ketogenic substances. These substances may contribute to the reduction of seizures. Ketones in urine have to be measured periodically.
Approximately a third of the children on a ketogenic diet becomes free of seizures. The seizures are reduced in another third and the diet has no effects in the last third. Kempenhaeghe performs scientific research to explain why a ketogenic diet is effective or not.
In Heeze, Kempenhaeghe utilizes the so-called MCT diet. The child eats a sophisticated diet of regular food, supplemented with a special fat emulsion. Using a ketogenic diet requires motivation, perseverance and discipline. The dietician counsels the parents and children intensively in learning how to use this diet in a creative way. Children who also use anti-epileptics may be able to adjust or taper off their medication.
Vagus nerve stimulation
Vagus nerve stimulation is a therapy to suppress epileptic seizures if treatment with medication fails and brain surgery is not possible. Both children and adults can be treated with vagus nerve stimulation. Seizures are reduces in approximately 30% of the patients and there are few adverse effects.
The vagus nerve is an important nerve in the neck connecting the brain with other parts of the body. Stimulating this nerve may reduce epileptic seizures. A small device (stimulator) is surgically implanted directly under the skin or under the pectoral muscle. An electrode connects the stimulator to the nerve. The stimulator can be set-up remotely to deliver a stimulus at certain moments.
Currently, approximately 60,000 people are treated with a stimulator worldwide. Kempenhaeghe plays a role in selecting patients for vagus nerve stimulation. Placement of the stimulator is performed in a (academic) hospital authorized and experienced in implanting vagus nerve stimulators. Adjustment of the stimulator takes place at Kempenhaeghe. Furthermore, Kempenhaeghe performs scientific research concerning the effects and mechanisms of action of vagus nerve stimulation.
Links for further information:
Information (in Dutch only) about vagal nerve stimulation from the Epilepsie Vereniging Nederland (Dutch Epilepsy Association):
please >>click here
International website about vagal nerve stimulation:
please >>click here
