Exciting new options for treating epilepsy and migraines

Let’s start with epilepsy. What is it? 

Epilepsy is a neurological condition in which a person has an increased risk of seizures. A seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in awareness, movements, or sensations. 

Anyone can develop epilepsy at any time, and it is one of the most common neurological conditions. Over the course of a lifetime, approximately 1 in 26 people will develop epilepsy. Seizures and epilepsy are more common in young children and in older adults. Sometimes we can point to a clear cause, such as brain injury or a stroke, but in many cases the cause is not known. 

Understanding this condition helps reduce stigma and makes it more likely that people will seek care and effective treatment. 

How do we treat epilepsy?

We have three distinct types of treatments: medications, surgery, and implantable devices.

We think of treatment in two broad categories: preventative treatments, which are intended to reduce the frequency of seizures, and rescue treatments, which are used during a seizure. 

What new preventative options are there for epilepsy? 

The first is medication. We now have more than thirty anti-seizure medications that we can use. We also know that if two good medications have not stopped a patient’s seizures, the chance of becoming seizure-free with additional medications goes down. 

One of the newest medications, called cenobamate, has been especially helpful for people whose epilepsy is hard to control. For those who have tried multiple medicines without success, cenobamate can sometimes make the difference.

The second option is responsive neurostimulation. This is a small device that is implanted in the skull. Its thin wires lead to the part of the brain where seizures begin. The device constantly monitors the brain and delivers a brief pulse of stimulation when it detects seizure activity, with the goal to stop a seizure before it spreads. 

Typically, this device is used in patients for whom medication has not proven effective, and when a surgical option is not possible. It gives us another way to reduce seizures and improve quality of life for patients who otherwise have limited options. 

What about rescue treatments for epilepsy seizures? 

Before 2019, the main emergency treatment for seizures at home was a rectal gel. As you can imagine, this can be challenging to administer to someone in the throes of a seizure.

In 2019, a nasal spray was introduced. This is much easier to use. In fact, it can be self-administered by a patient who detects a seizure coming on. It is highly effective, especially for patients who experience clear and recognizable auras such as nausea, a rising sensation from the stomach, or an unpleasant smell or taste. 

Changing gears…what is a migraine? 

A migraine is a common neurological condition that affects approximately one in six people. It is much more than just a bad headache. Migraines typically last at least 4 hours and often cause throbbing pain on one side of the head. They are usually accompanied by nausea, and strong sensitivity to light and sound. The pain almost always gets worse with movement or normal activity, which helps distinguish migraines from a standard headache. 

How do we treat migraines?

Just as with epilepsy, migraine medications fall into the categories of preventative and rescue. Treatment begins with older, well-established medications that have been proven to be both effective and safe. However, if those do not work, or cause unacceptable side effects, we have newer options. 

What are the newest preventative options for migraines? 

The most modern class of medication is the calcitonin gene-related peptide (CGRP) antagonist. CGRP is a protein that triggers migraine pain, and this drug works by blocking it. These new medications are available in three convenient forms: self-administered injections (monthly or quarterly), daily oral pills, or in-office intravenous infusions (typically every three months). 

For some patients, Botox injections may be an option. Botox is administered in the office, across the head and neck, every 90 days, to disrupt pain signals.

Lastly, there is a non-drug option. A prescription device called Nerivio is a cuff on the upper arm that stimulates the body's natural pain relief system. This is a great choice for pregnant women or those who prefer to avoid medication.

What’s the bottom line?

Both migraines and epilepsy are complex neurological conditions to treat. The good news is that both can be managed successfully. My goal is to work thoroughly and carefully with each patient to find the treatment plan that best controls symptoms while minimizing side effects and supporting quality of life.

Learn more about epilepsy and headache care at Trinity Health Michigan. 

Dr. Andersen Shemme is a board-certified neurologist and epileptologist. He attended St. George’s University School of Medicine in Grenada, completed his neurology residency at Trinity Health in Grand Rapids, and an epilepsy fellowship at the University of Michigan. Dr. Shemme has practice locations at Trinity Health Neuroscience Center in Muskegon and Trinity Health Medical Group, Neurology in Grand Haven.