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Epilepsy is not a stigma, the most severe cases are helped by surgery

People who have epilepsy can lead normal lives. The disease is not a stigma and medication works for a large proportion of patients. Several dozen patients with severe epilepsy a year undergo brain surgery in which surgeons remove the part of the brain responsible for seizures. Doctors at the Na Homolce Hospital are now working on a method that has so far been presented by only two world centres. It consists in not removing the so-called hippocampus, which is the trigger of seizures, but just cutting across it with several incisions. This way, people's memory is preserved and the seizures disappear. Martin Kovář, head of the neurology department at Homolka, said this in an interview with ČTK.

Experts say that some form of epilepsy affects half to one percent of the population, so up to 100,000 people in the Czech Republic may suffer from epilepsy. Every tenth to twentieth person has at least one seizure in their lifetime. In some people the disease disappears completely within a few years, in others it can be well influenced by medication.

"It is important to remember that epilepsy is a common disease. Most patients receive medication from their district neurologists. Then there is a minority of patients who, even though they receive medication, still have seizures. And they're often disabling seizures. They fall down, they hurt themselves," Kovář said. There are three specialised centres in the Czech Republic dedicated to the treatment of these most severe patients, in addition to Homolka, there are also centres in Motol and the St. Anne's University Hospital in Brno. If doctors find the part of the brain that triggers the seizures, they can surgically remove it. According to Kovář, up to a hundred such operations, so-called resections, are performed in the Czech Republic every year.

Some epilepsies originate in the so-called hippocampus, also called the seahorse, which is located in the innermost part of the temporal lobe and plays an important role in memory formation and recall. Humans have two hippocampi in the brain, one of which doctors can remove. At the Na Homolce Hospital, surgeons performed an operation before Christmas in which they did not remove the hippocampus, but made several incisions in it, which should stop the triggering of epileptic seizures. According to Kovář, the operation was successful and the patient left the hospital after seven days. "It appears that this could be a safe, gentle and effective method," Kovář noted. "A well-functioning interdisciplinary collaboration, in this case between a neurologist, neurosurgeon, radiologist and clinical psychologist, is necessary for successful treatment."

In some patients, even after extensive examinations, doctors cannot tell which part of the brain is the trigger or whether the trigger is located in several places. These patients then take medication and to reduce the frequency and length of their seizures, doctors insert a so-called vagal stimulator. "It looks like a pacemaker and is also put in the same place. The end of it is tied under the skin to the vagus nerve on the left side of the neck," the chief said.

Kovar said epilepsy is not a stigma. People who have it can lead normal lives. "You can have a lot of acquaintances around you, friends who are being treated for epilepsy, and you won't even know it. After some time since they had their last seizure, they can drive a car, work in normal situations, have a family life, they can play sports. There are just some limitations, they can't drink alcohol, they should have regular sleep, but it's nothing that will change their life in any way," the chief added.

Epilepsy drugs have also undergone major developments. According to Kovář, they now have far fewer side effects than the first generation of drugs. After them, patients were tired and also felt psychological changes.