On World Epilepsy Day 2024, Dr Atma Ram Bansal, Director, Neurology, Neurosciences, Medanta, Gurugram talks about Drug-resistant epilepsy (DRE)
Epilepsy is one of the most common brain disorders, affecting nearly 12 million people in India, which is 1/5th of the epilepsy cases worldwide, according to the IP Indian Journal of Neurosciences. Even with modern treatment, around 20–30 per cent of people with epilepsy have drug-resistant epilepsy.
Drug-resistant epilepsy (DRE) is where seizures cannot be controlled by medications, even after trying at least two anti-seizure medications at appropriate dosages. As standard treatments are ineffective, patients suffering from DRE face complex situations as seizures continue to disrupt their lives.
Causes of DRE
The causes of DRE are complex and can involve several factors, including:
Genetic factors: Some types of epilepsy are caused by specific gene mutations that make the condition harder to treat with standard medication
Brain abnormalities: Structural issues, like abnormal brain tissues, tumours or blood vessel malformations, are often linked to DRE. MRI can help detect these
Drug metabolism difference: some individuals bodies respond to drugs differently, affecting how well the meidcation works
Medication challenges: Issues like dosage, duration, and interactions between medications can limit effectiveness in seizure control.
Challenges of living with DRE
Living with DRE comes with its challenges, as uncontrolled seizures can cause injuries, impact mental health, and cause social isolation. Especially in India, where epilepsy carries a social stigma, adding another layer of difficulty, patients often face challenges in their daily lives, work, and relationships. As for healthcare providers, treating epilepsy can be tricky. Specialised care and advanced testing methods are needed to manage this condition effectively. Access to such care in some parts of India, especially rural areas, can be difficult, making it hard to diagnose and treat patients with DRE in such areas.
Managing DRE
Managing DRE requires a range of approaches, from medical treatments to lifestyle changes, including:
Surgery: If seizures start from a specific brain area, then surgery can be effective by removing that area or using neurostimulation to regulate activity
Ketogenic diet: The ketogenic diet that is high in fat and low in carbohydrate has proven to be effective for some patients with DRE, especially children. This diet can reduce seizure frequency by creating a state of ketosis, though it requires careful medical supervision
Deep Brain Stimulation (DBS): It involves implanting electrodes and sending electrical impulses in targeted areas of the brain to correct abnormal brain activity
Vagus Nerve Stimulation (VNS): It involves implanting a device that sends electrical impulses to the brain through the vagus nerve
Mental health and social support: living with DRE can take a mental and emotional toll on the patient. Support services, such as counseling, support groups, and social services, can help people with DRE manage the psychological impact of their condition. Having a strong support system can make a significant difference in quality of life.
In conclusion, DRE is a complex neurological condition that requires a range of treatments, from medications and surgery to dietary and psychological support. People with DRE often face significant challenges, but with the right care and support, they can manage their condition and live fulfilling lives. In India, improving awareness about DRE and ensuring access to specialized care can make a significant difference. As healthcare technology is rapidly advancing and ongoing research is exploring new treatments, there is hope for patients suffering from DRE.
- Advertisement -