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My Medications Aren’t Stopping My Seizures: What’s Next?

By U.S. News & World Report

Epilepsy is the fourth most common neurological disease, currently affecting at least 2.3 million adults and nearly 500,000 children in the U.S. Each year, another 150,000 people are diagnosed with epilepsy. The disorder affects both males and females and can develop at any age.

Epileptic seizures (and epilepsies) can be classified as focal or generalized. Focal seizures begin in one particular region of the brain, while generalized seizures are the result of abnormal neuronal (nerve cell) firing that affects the whole brain from the beginning.

The first step in the management of seizures is to confirm the diagnosis of epilepsy, as many patients suffer from what’s called psychogenic non epileptic seizures, or PNES. This is usually done through the recording of brain waves during seizures in a specialized setting called an epilepsy monitoring unit.

There are more than 20 medications approved in the U.S. for the treatment of various types of epilepsies. More than two-thirds of patients with epilepsy can control their seizures with one or more medications. Epilepsy is considered to be drug resistant if seizures continue despite treatment with two or more antiepileptic medications.

If the patient suffers from drug resistant focal epilepsy, surgery should be considered. Epilepsy surgery is an established and effective treatment option if the area of the brain from which the seizures start is adequately identified and safely resected. The identification of the seizure onset is performed in highly specialized epilepsy centers through the use of a series of tests. These tests include the recording of the brain waves (electroencephalogram) during the seizures in the epilepsy monitoring unit. The EEG may help identify the region of the brain from which the seizures start. A high resolution brain scan (magnetic resonance imaging) is required, as it may identify an area of structural abnormality in the brain. The epilepsies have many possible causes, ranging from abnormal brain development to traumatic brain injury or illness. These malformations lead to abnormal brain wiring that occurs during brain development, an imbalance of neuron signaling chemicals called neurotransmitters, or a combination of these factors. In some cases, inflammation and neuronal damage after a head injury, stroke, small vascular malformations or other trauma may lead to epilepsy. In these cases, the brain’s attempts to repair itself after such injury may inadvertently generate abnormal nerve connections that lead to seizures.

Other tests may be needed to further assess the function of the seizure generating areas and minimize the negative impact of the surgery on essential functions of the brain and increase the safety of the resection. One of these tests is functional magnetic resonance imaging to “map” language and memory zones prior to surgery. Another brain mapping technique called magnetoencephalography may be used to pinpoint the seizure onset and to evaluate language processing and preserve key language zones during epilepsy surgery. The most common type of surgery involves the removal of a seizure focus, the small area of the brain where seizures originate. This type of epilepsy surgery may lead to long-term complete seizure freedom in more than half of the drug resistant patients with focal epilepsy.

Other surgical procedures such as corpus callosotomy (severing of the nerve fibers that connect the two sides of the brain) or hemispherectomy (removal of half of the brain) may be used in selected cases. Minimally invasive MRI-guided laser surgery is being increasingly used in large epilepsy centers for the treatment of epilepsies associated with tumors, as well as small lesions. The technique involves drilling a very small hole in the skull, through which a thermal laser is inserted to ablate an epileptic area under MRI-guidance.

Other non-medical options such as electrical stimulation of the brain or parts of the brain may be considered. The types of stimulation include: deep brain, intracranial cortical, peripheral nerve, vagal nerve and trigeminal nerve. A promising application is the development of implantable devices that can detect the early start of the seizure. Once detected, the implanted device administers an intervention, like electrical stimulation to prevent the seizure from occurring. One such device that has been approved in the U.S. is the NeuroPace RNS system (known as responsive stimulation).

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My Medications Aren’t Stopping My Seizures: What’s Next? originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

By WTOP Staff
Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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