MS15.pdf

10/24/23, 3:40 PM Realizeit for Student Prevention Society-wide efforts are the key to prevention of epilepsy. Head injury is one of the main causes of epilepsy that can be prevented. Through highway safety programs and occupational safety precautions, lives can be saved and epilepsy due to head i...

10/24/23, 3:40 PM Realizeit for Student Prevention Society-wide efforts are the key to prevention of epilepsy. Head injury is one of the main causes of epilepsy that can be prevented. Through highway safety programs and occupational safety precautions, lives can be saved and epilepsy due to head injury prevented. Medical Management The management of epilepsy is individualized to meet the needs of each patient and not just to manage and prevent seizures. Management differs from patient to patient, because some forms of epilepsy arise from brain damage and others result from altered brain chemistry. Surgical Management Surgery is indicated for patients whose epilepsy results from intracranial tumors, abscesses, cysts, or vascular anomalies. Some patients have intractable seizure disorders that do not respond to medication. A focal atrophic process may occur secondary to trauma, inflammation, stroke, or anoxia. If the seizures originate in a reasonably well-circumscribed area of the brain that can be excised without producing significant neurologic deficits, the removal of the area generating the seizures may produce long-term control and improvement (AANN, 2016a). This type of neurosurgery has been aided by several advances, including microsurgical techniques, EEGs with depth electrodes, improved illumination and hemostasis, and the introduction of neuroleptanalgesic agents (droperidol and fentanyl). These techniques, combined with the use of local anesthetic agents, enable the neurosurgeon to perform surgery on an alert and cooperative patient. Using special testing devices, electrocortical mapping, and the patient’s responses to stimulation, the boundaries of the epileptogenic focus (i.e., abnormal area of the brain) are determined. Any abnormal epileptogenic focus is then excised (AANN, 2016a). Resection surgery significantly reduces the incidence of seizures in patients with refractory epilepsy. When seizures are refractory to medication in adolescents and adults with focal seizures, a vagal nerve stimulator (VNS) may be implanted under the clavicle. The device is connected to the vagus nerve in the cervical area, where it delivers electrical signals to the brain to control and reduce seizure activity. An external programming system is used by the primary provider to change stimulator settings (Tzadok, Harush, Nissenkorn, et al., 2019). Patients can activate the stimulator with a magnet at the time of a seizure or aura. Some patients report that use of the VNS diminishes the severity or duration of the seizure. Complications such as infection, cardiac arrhythmias, hoarseness, cough, and laryngeal spasm can occur with the use of this device (AANN, 2016a). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 1/2 10/24/23, 3:40 PM Realizeit for Student Another surgical option for patients with refractory seizure activity is the responsive neurostimulation system (RNS). This is a surgically implanted device with electrodes that sense and record brain electrical activity. Electrodes deliver an electrical stimulation to the location of seizure origination within the brain. The RNS works by interrupting brainwave activity before a clinical seizure can occur (Wong, Mani, & Danish, 2019). For patients with well-defined or anatomically deep epileptogenic lesions, MRI-guided stereotactic laser interstitial thermal therapy (LiTT) offers a less invasive treatment option. This treatment involves computer-assisted placement of a laser probe into the brain and delivery of heat therapy. Decisions about epilepsy surgery are complex, and these patients should be referred to epilepsy centers for further evaluation (Crepeau & Sirven, 2017). More research is needed to determine the effects of the various surgical approaches on complication rates, quality of life, anxiety, and depression, all of which are issues for patients with epilepsy. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 2/2