Uncontrolled Seizures: Their Sobering Implications and the Case for Surgical Interventions (Podcast)

Exploring when and how to consider epilepsy surgery or neuromodulation

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Recent data from the Centers for Disease Control and Prevention show that more than half of U.S. adults who take epilepsy medications still have seizures. This fact has made Cleveland Clinic Epilepsy Center Director Imad Najm, MD, a vocal advocate of the guideline recommendation that patients consider other treatment options — including epilepsy surgery and neuromodulation — when two or more anti-epileptic medications fail to prevent their seizures.

In the newest episode of Cleveland Clinic’s peer-to-peer Neuro Pathways podcast, Dr. Najm discusses what we now know about pharmacoresistant epilepsy and the latest advances in identifying candidates for epilepsy surgery or neuromodulation therapies. Among the topics explored:

  • Implications of medically intractable and uncontrolled seizures
  • Identifying the best candidates for epilepsy surgery
  • The comparative profiles of three available neuromodulation therapies for refractory epilepsy
  • Why surgical outcomes are so varied
  • How technologies for epilepsy presurgical evaluation have become less invasive and more revealing over the past decade

Click the player above to listen to the 20-minute podcast now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Dr. Najm: The number of epilepsy surgeries done in the United States is close to 3,000 per year. It is estimated that around 150,000 patients are surgical candidates in the United States alone. Plus, it’s estimated that we have another 15,000 patients per year who will become surgical candidates in addition to the 150,000. This data is sobering because it tells us that even in a country like the United States, where we have access to high-level medical resources, epilepsy surgery is not used to the extent it should be.

It is very important to know that seizures can lead to disability, fractures, head injuries, bodily injuries and skin injuries. In addition, seizures that are not controlled — even one seizure every five years — can lead to a significant increase in sudden unexpected death in epilepsy (SUDEP). The risk of SUDEP increases up to 15 times in patients who have recurrent seizures, in particular those who suffer from generalized convulsive seizures.

Data clearly show that the only way we can eliminate the risk of SUDEP is through complete control of seizures, not partial control. That’s why when we are asked, “What is your goal in treating patients with epilepsy?” the answer is very simple: zero seizures. It’s not like, “Oh, this patient has one seizure per month during the nighttime. It’s not disabling them.” It may not be disabling them, but it’s putting their life at risk.