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Anticonvulsants control epileptic seizures in at least two of three patients. For these lucky two, it can seem that everything works, both old drugs and new. Treatment decisions can be based on side effects and price. It is more difficult for the unlucky one.
Patients with intractable epilepsy may benefit from experimental drugs, but the standard for a successful trial is relatively modest: 50% improvement in 50% of patients. Sometimes, the patient is a candidate for surgery, by resection,1 transection,2 or section.3 The best results seem to occur with temporal lobectomy, which completely controls complex partial and generalized seizures at least half the time,1 but because many patients continue to have seizures, we continue to look for better treatments.
The vagal nerve stimulator (VNS) was the first example of a new approach toward seizure control, but this device generally reduces, rather than eliminates, seizures. The device cycles on and off constantly, but extra cycles can be initiated by placing a magnet over the device. Patients use the magnet when they think they will soon have a seizure, and this aborts or ameliorates the …
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