New treatment modalities in epilepsy

India has evolved and providing good quality healthcare in the treatment of epilepsy. But still, there is a lot more to achieve, to integrate every sector, every corner of India into mainstream healthcare. 

Before venturing into the new treatment of epilepsy, let us know about a new concept in medicine. It is called the precision medicine approach. Concept of precision medicine – It is an approach that tends to use genetics, environment and lifestyle of individuals to help determine the best way to prevent or treat disease. In other words, this approach involves holistic treatment that is tailored for a particular patient taking into account multiple factors which can affect disease, its treatment and outcome rather than one shoe fits all. Keeping this approach in mind we will discuss newer treatment modalities in epilepsy.

New modalities of treatment include pharmacological treatment and non-pharmacological treatment.

Pharmacological treatment: In the last three decades, many new antiepileptic drugs have come. They have equivalent efficacy but fewer side effects. Levetiracetam, brivaracetam, lamotrigine, topiramate and perampenal are some examples of newer antiepileptics. Cannabidiol is the newest addition to the list. However, it should be remembered that they are not over-the-counter drugs and should be used with physician consultation in certain indications only. 

As per the precision medicine approach also we need to assess the efficacy, side effect profile and financial capacity of patients before giving the medicines. For example: Drug A is quite effective in patient X, but producing too much sedation and he is not able to work due to drowsiness. While drug B in patient X is a little less effective than drug A but not making him drowsy and he can work and earn his daily wages. Therefore, the patient wants to take drug B.

Non-pharmacological treatmentIt includes dietary modification, environmental modification and various interventional treatments

Dietary modification: The ketogenic diet has been known for a long time to have beneficial effects on epilepsy. However, some forms of genetic epilepsy respond remarkably well to the ketogenic diet.

Environmental modification: I will explain this with an example. A child during seizure used to fall and get a facial injury or head injury during seizures. Multiple medicines were tried but did not work much. Parents were very much concerned about injury during seizures even if that part could be somehow reduced, parents will be happy. So, they were advised to wear a boxing helmet while going outside which significantly reduced the injury to the head and face during seizures.

Surgical options: Various epilepsy surgeries are available for those who are having refractory epilepsy(Seizures not responding to medicines). Epileptogenic area resection, Vagal nerve stimulation and deep brain stimulation are some of the options. These procedures require assessment by a specialist and will not apply to all patients.

Novel non-pharmacological, non-surgical options: Few patients who don’t want surgery for them or surgery is not possible due to certain reasons, can avail benefits from such procedures. They include Transcutaneous vagal nerve stimulation, transcranial magnetic stimulation transcranial direct current stimulation etc.

Evolving therapies (still in trial phases): Gene therapy, and stem cell therapy in epilepsy may have a role in future. 

How has India evolved in terms of epilepsy treatment

India has evolved a long way in the treatment of epilepsy. Most of the possible investigations and treatment options are available in India although availing some of them may be limited due to financial constraints.

Still Indian Health care system is offering all these treatments at a lower cost as compared to Western counterparts, be it medicine or surgical options.

However, still, there is a treatment gap (many patients in need of treatment for epilepsy are not getting treatment). Reasons for that are multiple including:

  • Lack of awareness about epilepsy and its treatment
  • Social stigma: Unwillingness or not accessing healthcare due to cultural beliefs or social stigma
  • Financial constraints
  • Lack of availability of trained healthcare personnel/institutes capable of handling such patients.

To conclude, with precision medicine approach treatment of epilepsy and other diseases will improve. India has evolved and providing good quality healthcare in the treatment of epilepsy. But still, there is a lot more to achieve, to integrate every sector, every corner of India into mainstream healthcare. It will be possible through the collective efforts of the involved entities.

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