Dr Andrew Mallick
Consultant Paediatric Neurologist, Bristol Royal Hospital for Children
Mr Michael Carter
Consultant Paediatric Neurosurgeon, Bristol Royal Hospital for Children
Epilepsy can cause seizures and developmental problems, and may not respond to medication. Yet those with a drug-resistant form of the condition still have treatment options.
Epilepsy — a serious neurological condition which can cause seizures — affects around 600,000 people in the UK and is a surprisingly common childhood disorder.
“Thankfully, the majority of children will be able to control their epilepsy with medication,” says Dr Andrew Mallick, Consultant Paediatric Neurologist at the Bristol Royal Hospital for Children. “But a proportion of them will be drug-resistant — which means medication won’t control their condition.”
In fact, drug-resistant epilepsy (DRE) affects around 30% of the epilepsy population.
The longer their epilepsy continues, the more developmental challenges they’re likely to face. However, evidence shows that early intervention can reverse this.
“Poorly controlled seizures are a major problem for a number of reasons,” explains Mr Michael Carter, Consultant Paediatric Neurosurgeon at Bristol Royal Hospital for Children. “One of which is a phenomenon called SUDEP – or Sudden Unexpected Death in Epilepsy – which is a significant risk for those with uncontrolled seizures,” he says.
Yet seizures aren’t the only concerning aspect of epilepsy, because it can also cause psychological, educational, emotional, behavioural, social and development issues.
“This is why we say that epilepsy doesn’t just affect the patient…” says Mr Carter, “it affects entire families. If you’re living with a child who has epilepsy, you’re completely focused on dealing with them and the risks and issues associated with their condition.”
Early treatment options for the best results
There is, however, hope for those with DRE. If medicine doesn’t work, brain surgery (to either remove or disconnect an area of brain acting as a seizure source) may either reduce the frequency of seizures or stop them altogether.
Patients with DRE who are unsuitable for brain surgery may benefit from VNS (vagus nerve stimulation) therapy, where a pacemaker-like device sends mild pulses to the vagus nerve at regular intervals throughout the day in an effort to stop seizures before they start.
The VNS device is implanted under the skin of the chest during a procedure which usually takes an hour-and-a-half, and patients are normally able to go home on the same day as surgery.
The therapy doesn’t work for everyone and usually doesn’t result in complete seizure freedom.
“The VNS device can be extraordinarily effective in suppressing seizures and improving the quality of life of children with drug-resistant epilepsy and their families too.” says Mr Carter.
Dr Mallick stresses that whatever treatment drug-resistant patients are given, receiving it earlier is likely to yield the best results.
“The longer their epilepsy continues, the more developmental challenges they’re likely to face,” he says. “However, evidence shows that early intervention can reverse this.”
