# Tarheel Health Portal/Epilepsy

Epilepsy is a condition that causes repeated seizures, unusual and sudden bursts of electric activity in the brain. Seizures cause loss of muscle control, movement, speech, vision, or awareness problems in the affected individuals. In the United States, approximately 4.3 million adults have a history of epilepsy and approximately 2.4 million adults have active epilepsy. Epilepsy is officially diagnosed when a person has had two or more seizures. Epilepsy has since been treated with traditional medicine and surgical options that help contain and even erase the symptoms characteristic of epilepsy. However, in the recent years, the scientific community has explored non-pharmacological and noninvasive treatments for epilepsy as effective options for treatment. Also, without surgery, unnecessary risks are bypassed and the patients do not have to spend extra time recovering from various operations.
At UNC, the students could easily know someone close to them that has epilepsy. This article could help them learn what epileptic patients go through on a daily basis, the treatments that they take, and ways to help them in case they have a seizure around others.

## Emergency Epilepsy Treatments

Things to do when someone has a seizure:
* Prevent an injury by removing anything hard or sharp around the person who is having the seizure
* Put the person on the floor and put something soft and flat underneath their head
* Remove glasses and loosen ties around the neck so breathing is not difficult
* Time the seizure, if the seizure is more the five minutes long, they are having difficulty breathing, or are injured, call 911
* Do not hold the person down
* Do not put anything in their mouth
* Try to turn the person onto their side
* Do not offer the person food or drink until they are fully awake

## Nonpharmacological and Noninvasive Treatment Options
### The Ketogenic Diet

The Ketogenic Diet requires patients to consume a high fat, low protein, and low carbohydrate diet along with calorie restriction. Since the ketone bodies and fatty acids will be manipulated through the Ketogenic Diet, there will be more controlled amounts of glucose in the system, resulting in seizure control. Also, these benefits stabilize the synaptic function in the brain through the neurons and axons, while also increasing the resistance of seizures in the brain. The Ketogenic Diet causes chronic ketosis and changes the tricarboxylic acid cycle, which increases GABA synthesis and energy production in the brain. Within the Ketogenic Diet are symptoms that result in inhibitory neurological actions from the brain because of the increased occurrence of polyunsaturated fatty acids. Since there is a small amount of glucose coming from the Ketogenic Diet, that adds enhanced oxidative phosphorylation and decreases glycolytic flux. Glycolytic flux is thought to start metabolic K$_{ATP}$ channels and hyperpolarize the neurons/glia in the brain. These changes in the brain due to the Ketogenic Diet are all benefits to the treatment of epilepsy in adults. Also, these benefits seem to stabilize the synaptic function in the brain through the neurons and axons, while also increasing the resistance of seizures in the brain.
The Ketogenic Diet has been proven to be a viable and effective epilepsy treatment option by various studies. In a study done by Dr. Kossoff in 2007, they used thirty patients, who were adults from 18-53 years old, had weekly seizures, and had a previous use of at least two anticonvulsants. The patients were put on the Ketogenic Diet, but were also restricted by the doctors with encouraged fats, allowed proteins, fluids, and calories, and also an initial carbohydrate restriction to 15 grams per day. 47% had a greater than 50% reduction in their seizures after 1 and 3 months on the Ketogenic Diet, along with 33% after 6 months on the diet. The median improvement time for seizures was about 2 weeks with a 1-8 week range. The Ketogenic Diet has proven its effectiveness many times in experiments and clinical trials, giving patients peace of mind when they approach it as a treatment option.

### EEG Biofeedback

Electroencephalography Biofeedback, or EEG biofeedback, has been explored in the neurology field as becoming a new treatment option for patients with epilepsy. EEG biofeedback can also be referred to as EEG operant conditioning or neurotherapy. Operant conditioning is when patients learn by associating positive and negative effects with certain behaviors. With this kind of conditioning, patients learn how to individually control their own EEG rhythm and independently take control over their seizures. In a study done by Dr. Tan in 2009, he compiled the data from ten separate studies in which the patients had uncontrollable seizures that could not be treated with medicine. The average of the studies showed a mean decrease in seizures after the EEG biofeedback. Also, 74% of the patients had fewer weekly seizures because of the EEG biofeedback. Based on the results of this study, EEG operant conditioning had a significant decrease on the patients’ seizure frequencies. EEG biofeedback has been studied since the 1970s and was focused on the sensory motor rhythm as a baseline for effectiveness of the treatment. The effectiveness of EEG biofeedback as a viable and effective treatment option has been researched since then.
In a study by Dr. Sterman, 174 patients with epilepsy were enrolled to see if EEG biofeedback would have an impact on the frequency of their seizures. 82% had improvement and 30% became free of their seizures. 50% had a decrease in seizure frequency and severity, and an additional 5% had total control of their seizures after one year of using EEG biofeedback as treatment.

### Yoga

The practice of yoga has been used for relaxation, connecting to the spiritual side of oneself, and also to achieve increased flexibility. In the neurological field, yoga is being explored more and more as an adjuvant care option along with regular epilepsy treatment options or non-pharmacological/non-invasive options like the Ketogenic Diet and EEG biofeedback. There are several yoga methods and techniques used to treat and control epilepsy by involving the whole body in the healing process. In contrast, most medical treatments are concentrated strictly to the brain and the nervous system when administered to the patient. The goal of yoga is to try to establish a stable equilibrium between the parts of the patients’ bodies that are related to seizures and restore their health.
The pranayama method, also known as deep breathing, is used for patients to train themselves to hold their breath if they fall into a seizure. This causes metabolism, blood flow, and blood oxygen level changes, which helps to bring back normal respiration. This change in breathing can lower the chances of a patient going into a seizure, or stop the seizure before it reaches its peak. In a study done by Dr. Lundgren, eighteen patients were monitored to evaluate if yoga practices actually helped control seizures and increased quality of life. The results of the study showed that yoga did significantly reduce the patients’ amount of seizures while at the same time increasing their quality of life.
The posture method, or asanas and yogasanas, regulates the body and metabolic systems. Asanas builds physical stamina and relaxes the nervous system. Also, it increases “circulation, respiration, and concentration”, while also lowering the chances of having another seizure. The posture method also improves the patients’ quality of life.
Meditation, or dhyana, is another widely used branch of yoga. Mediation relaxes the mind, while naturally and spiritually repairing the bodies of epileptic patients. It also slows down stress hormone production while increasing blood flow to the brain, and increases neurotransmitter levels. For example, serotonin is released, which keeps the body’s nervous system relaxed. A study was done in India in 2006 that assessed the effects of meditation on twenty patients with epilepsy. 95% of the patients had a reduction in their seizures. Also, eight patients continued with the meditation for more than six months, and afterwards three patients were declared seizure free. All of the effects of dhyana help patients consciously control their seizures. Yoga is effective for reducing the frequency of epilepsy in epileptic patients and at the same time increasing their quality of life.

## Resources at UNC/Further Readings

UNC Hospitals have a wide range of epilepsy services, including a Comprehensive Epilepsy Center. Many research teams at UNC Hospitals are conducting studies in the wide range of neuroscience and neurobiology, while also focusing on epileptic patients and seizures.
* [UNC Hospital Comprehensive Epilepsy Center]
* [Frequently Asked Questions About Epilepsy]
* [First Aid for Seizures]
* [Epilepsy Treatments]
* [UNC School of Medicine Department of Neurology]