Overcoming Patient-Related Challenges: Access to Care in Drug-Resistant Epilepsy
Clinicians face multiple patient-related challenges in the treatment of epilepsy, including social isolation, lack of mobility, and lack of support. Our featured expert shares his perspectives on overcoming such challenges, paying particular attention to drug-resistant epilepsy and access to care.
“Surgery and neurostimulation can be game changers in drug-resistant epilepsy, bringing patients with years-long histories of uncontrolled seizures to the point where they can once again drive, hold down jobs, and have otherwise normal lives.”
The good news is that two-thirds of those with epilepsy will become seizure free on the first or second trial of an antiepileptic
drug (AED). Unfortunately, approximately one-third of patients have drug-resistant epilepsy and will continue to suffer uncontrolled seizures, despite additional AED drug therapy. It is important to look for other options in these cases. Surgery may be an option if the seizures are partial or focal in onset, as long as they do not originate in eloquent cortex (ie, areas of the brain that are essential for speaking, laying down new memories, and moving the opposite side of the body). In appropriately selected cases, surgery has demonstrated a greater than 70% chance of achieving complete seizure freedom. In patients with drug-resistant epilepsy who cannot be treated with surgery, various forms of neurostimulation (eg, vagus nerve stimulation, deep-brain stimulation, responsive neurostimulation) may help to reduce their seizures without the side effects that often accompany AED therapy, such as tiredness and drowsiness.
Surgery and neurostimulation can be game changers in drug-resistant epilepsy, bringing patients with years-long histories of uncontrolled seizures to the point where they can once again drive, hold down jobs, and have otherwise normal lives. These care options, however, typically require the capabilities of a comprehensive epilepsy center. One of the biggest issues facing patients with epilepsy is access to care, as not every patient has access to a comprehensive epilepsy center with coordinated care involving neurosurgery, neuropsychiatry, and other specialties; magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography scanning; and an epilepsy monitoring unit, where seizures can be provoked and studied safely using electroencephalogram. These centers do not exist everywhere, and many patients do not even know that these care options are available. Further, social isolation and mobility are significant issues for many patients with epilepsy, and, as the availability of these comprehensive epilepsy centers is limited, some patients may have to travel considerable distances to the nearest facility.
In summary, awareness is critical to overcoming epilepsy treatment challenges. Everyone in the neurology community, from general neurologists to epilepsy specialists to nurse practitioners, must be knowledgeable about the various available treatment options to ensure that our patients with epilepsy receive the most appropriate care.
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