Personalized treatment
Most people with epilepsy take medications known as anti-seizure medications. Our neurologists are familiar with all seizure medications and understand how to combine different treatments effectively. Finding the right medication for you can sometimes be very challenging. Medications may become less effective over time, or you may experience too many side effects. In such cases, alternative treatments may be considered.
If seizures can be controlled with anti-seizure medications, your referring physician can resume managing your treatment, of course, in consultation with you.
When other treatment methods are considered, additional testing is usually required. This may involve consulting more specialists from the Academic Center for Epileptology and, in some cases, experts from other hospitals. The search for the most suitable treatment can have a significant emotional impact, which is why extra support and guidance are available to help you through the process.
Medications for epileptic seizures
Most people with epilepsy take medication to control seizures. These are called anti-seizure medications. For most patients, a suitable medication is found relatively quickly that effectively manages epilepsy with minimal side effects. However, in some cases, this is not successful, and Kempenhaeghe may be able to help.
Have you or your child tried two different medications and/or been unable to become seizure-free within two years? If so, a referral to specialized epilepsy care is recommended. A referral is also necessary if an anti-seizure medication is effective in controlling seizures but causes unacceptable side effects.
The neurologists at the Academic Center for Epileptology Kempenhaeghe/Maastricht UMC+ have extensive knowledge and experience with all available anti-seizure medications and their possible combinations and side effects. The neurologist selects the most suitable medication and dosage for you or your child, considering the cause of the seizures and any other medications already in use. Once the medication is properly adjusted, you or your child will typically be referred back to your primary physician.
Other Treatments
If available medications are not sufficiently effective, the neurologist may explore alternative solutions and non-medication treatments. In some cases, there may also be an opportunity to participate in clinical research involving new, promising medications that have not yet been approved.
Epilepsy surgery: Brain surgery to become seizure-free
Epilepsy surgery, a brain operation, aims to make people with epilepsy seizure-free. Patients may be eligible for this surgery if they continue to experience seizures despite medication, significantly impacting their daily lives. The key conditions for surgery are that the seizures originate from a specific part of the brain and that this area—the epileptic focus—can be safely removed or disabled without causing severe damage, such as paralysis, speech loss, or memory impairment.
The potential benefits of the surgery must outweigh the risks. If your neurologist believes that brain surgery could be a treatment option for you or your child, you will undergo a thorough and careful evaluation process. This includes multiple preoperative examinations over an extended period, such as (multi-day) seizure monitoring, MRI scans, and neuropsychological assessments.
Most preparatory tests and seizure monitoring are conducted at our expertise center. However, you or your child may need to visit Maastricht UMC+ or Amsterdam UMC for certain examinations. The brain surgery itself is performed at Maastricht UMC+.
Watch the children's video on epilepsy surgery here.
Evaluating after each step
The process surrounding brain surgery can be intensive and lengthy. At each step of the process, a Special Epilepsy Surgery Working Group determines whether there is a sufficient chance of success to proceed. This working group consists of medical specialists from epilepsy centers and academic hospitals. Together with your neurologist and a specialized nurse, you will discuss at each phase of the process, and after receiving a "green light" from the working group, whether you also wish to continue. After the brain surgery at the academic hospital, you or your child will return to Kempenhaeghe for the post-operative care process.
Watch the videos
Are you and your doctors considering brain surgery with the goal of becoming seizure-free? In a series of videos from the Academic Center for Epileptology, a collaboration between Kempenhaeghe and MUMC+, you can see how the entire process works. You will also meet several patients who share what this journey has meant for them.
Deep Brain Stimulation (DBS)
Deep Brain Stimulation (DBS) is a relatively new treatment method for epilepsy in the Netherlands. A neurostimulator, a type of pacemaker, is implanted in the body and connected to the brain via under-skin wires.
The stimulator is adjusted several weeks after implantation. Finding the most effective setting for the best results may take some time. Deep Brain Stimulation does not involve removing brain tissue. If the treatment does not work or is poorly tolerated, the system can be turned off or entirely removed.
DBS is usually applied in combination with anti-seizure medications. It can be considered when medications are insufficient, and brain surgery is not an option. Children cannot yet be treated with Deep Brain Stimulation.
If your neurologist believes that Deep Brain Stimulation may be suitable for you, you will go through an extensive process, including several preliminary examinations over an extended period. The preliminary tests and the adjustment of the neurostimulator are mainly conducted at Kempenhaeghe in Heeze. The implantation of the system is performed at Maastricht UMC+.
Vagus Nerve Stimulation (VNS)
If medications are not sufficient to control epileptic seizures and brain surgery is not an option, both children and adults may receive an alternative treatment: Vagus Nerve Stimulation (VNS).
The vagus nerve is an important nerve in the neck that connects the brain with other parts of the body. Stimulating this nerve can reduce epileptic seizures in about forty percent of patients. This treatment has few side effects.
How Does It Work?
During surgery, a small device is implanted just under the skin or beneath the chest muscle. This stimulator is connected to the vagus nerve via an electrode. The stimulator can be remotely adjusted to deliver electrical pulses at specific times. In some cases, the stimulator can also deliver a pulse in response to rapid changes in heart rate, which often occur during seizures.
The placement of the stimulator is performed in an NVS-certified hospital. At Kempenhaeghe, we then adjust the stimulator for optimal treatment.
Ketogenic Diet for difficult-to-treat Epilepsy
If epilepsy medications are not effective or the side effects are unacceptable and brain surgery is not an option, the number of seizures may possibly be reduced by a special diet.
The principle of the ketogenic diet revolves around a high-fat diet with low carbohydrates (starch and sugars) and a normal amount of protein. When your body burns fat for energy, waste products are released. We call this ketones. The body enters ketosis: carbohydrates are not used as fuel, but fats.
Clarity within four months
Scientific research shows that the diet works positively for thirty to fifty percent of patients. As a treatment for epilepsy, it works only if you follow the diet very strictly. Usually, within four months, and sometimes even earlier, it will be clear if the diet leads to an improvement. You will follow the diet for two years or longer. If the diet does not help, it will be gradually phased out over a few weeks.
Forms of the ketogenic diet
Kempenhaeghe applies various forms of the ketogenic diet, including the MCT diet, the classic ketogenic diet, and the modified Atkins diet (MAD).
In the MCT diet, in addition to a carefully planned diet of regular foods, you are given a special fat emulsion. The MCT diet and classic ketogenic diet are recommended for children. The third form, MAD, is applied for adults and, in specific situations, also for children.
Careful guidance with the diet
Adjusting to and following the diet requires careful guidance from a specialized dietitian, nurse specialist, (pediatric) neurologist, a pediatrician (for children), and an internist (for adults).
