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Living with Epilepsy: Treatment Options

November 12th, 2024  | Epilepsy  | News

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Hypoxic-Ischemic Encephalopathy (HIE) is a brain injury resulting from a lack of oxygen and blood flow, often during birth. Children with HIE face various challenges depending on the severity and extent of the injury, with epilepsy being one of the most common long-term conditions associated with HIE. Epilepsy, a neurological disorder that leads to recurrent seizures, can range in severity and impact daily life in unique ways for each person. Understanding treatment options—ranging from medications to lifestyle changes—can empower families and individuals affected by HIE and epilepsy to make informed decisions.

1. Medication Options for Epilepsy Management

Medication is usually the first line of treatment for epilepsy and can be effective for many patients in controlling seizures. The type of medication prescribed depends on the specific type of seizures, age, weight, and overall health profile.

Each person responds differently to these medications, and families should work closely with healthcare providers to adjust doses and monitor for side effects. For children with HIE, especially those with other health conditions, finding the right medication can take time, and doctors may try several options to find the best fit.

2. The Role of Diet: Ketogenic and Modified Diets

For some children and adults who do not respond well to medications, dietary therapy can be an alternative or supplementary treatment. The ketogenic diet, for instance, has shown promising results in reducing seizure frequency in some patients with drug-resistant epilepsy.

• Ketogenic Diet: This high-fat, low-carbohydrate diet encourages the body to use fats rather than carbohydrates for energy. By altering the body’s metabolism, the diet can reduce seizures in some individuals, especially children with intractable epilepsy. However, it requires careful planning and medical supervision to ensure adequate nutrition and avoid side effects.
• Modified Atkins Diet and Low Glycemic Index Treatment: These are less restrictive dietary approaches that still emphasize low carbohydrates but may be easier to follow and maintain. They provide some of the benefits of the ketogenic diet but are typically more manageable for families.

Families interested in dietary treatments should consult with a dietitian experienced in epilepsy management to ensure the diet is both safe and effective. These modifications can be dangerous without the close supervision of a medical team.

3. Lifestyle Modifications and Seizure Management

Lifestyle changes can have a profound impact on managing epilepsy, particularly in children with HIE who may have other health and developmental considerations. Key strategies include:

• Sleep Hygiene: Sleep deprivation is a common trigger for seizures, so establishing a consistent sleep routine is essential.
• Stress Reduction: While stress is a normal part of life, it can trigger seizures in some individuals. Techniques like mindfulness, yoga, and regular physical activity can be helpful in managing stress.
• Safety Measures: For children prone to falls or injuries during seizures, using protective headgear, seizure alert devices, and modifying the home environment for safety can help reduce injury risk.

Lifestyle modifications can empower families to create an environment that minimizes seizure risk and improves quality of life. These strategies often complement medical or dietary treatments, creating a holistic approach to care.

4. Surgical Options for Drug-Resistant Epilepsy

In cases where seizures are resistant to both medications and dietary changes, surgery may be considered. Surgical options depend on the location and type of seizures and may include:

• Focal Resection: This surgery removes the part of the brain where seizures originate. It’s only an option if the area can be safely removed without affecting critical functions.
• Corpus Callosotomy: In this procedure, surgeons sever the connection between the two halves of the brain to reduce seizure spread. It doesn’t prevent seizures but can reduce their severity.
• Vagus Nerve Stimulation (VNS): VNS is a less invasive option that involves implanting a device that stimulates the vagus nerve, which can help reduce seizure frequency and intensity.

These procedures are often reserved for cases where other treatments have proven ineffective and are typically considered only after extensive evaluation by an epilepsy surgery team.

We recommend contacting the Pediatric Epilepsy Surgery Alliance for specific support and information about surgical options.

Moving Forward: Finding the Right Combination of Treatments

Every child and adult with HIE and epilepsy experiences their condition uniquely, which means that treatment approaches must be personalized. The right combination of medication, diet, lifestyle changes, and, in some cases, surgery can improve outcomes, but it often takes a team approach with neurologists, dietitians, therapists, and supportive family members working together.

For families navigating epilepsy due to HIE, education and support are critical. Organizations like Hope for HIE provide valuable resources, community support, and advocacy to help families understand and manage complex medical needs. By exploring these treatment options and staying informed, families can create a proactive plan that enhances the quality of life for those affected by HIE and epilepsy.