Freiburg Epilepsy CenterDepartment of Neurosurgery

With the help of special drugs, so-called antiepileptic drugs, on aims at preventing upcoming seizures. We use all known medications for epilepsy, if necessary also medications that are only approved outside Germany. We also use all newly approved drugs, so that you always receive modern epilepsy treatment adapted to your individual needs. In monotherapies and combinations of drugs, we strive to achieve the best possible tolerability. As a large university epilepsy centre, we take part in scientific studies (set link). This offers you the opportunity to receive new drugs at a very early stage.

Approximately 30% of patients do not achieve a satisfactory result from medical treatment. If remaining seizures impair the quality of life, the evaluation of a surgical treatment option is important. The goal of such a surgical intervention is to specifically remove the area from which the seizures originate. Accordingly, a locally definable cause of the epilepsy is a precondition. The Neurocentre Freiburg has made a major contribution to the development and establishment of surgical techniques in the treatment of epilepsy. The localisation and subsequent removal of the affected area is a great challenge, in particular in patients with often subtle malformations of cortical development. The interdisciplinary cooperation of specialists from different departments and neuropsychologists ensures excellent treatment results. You can find further information on the surgical procedures here.

If surgical procedures are no option, new treatment methods using brain stimulation techniques can also be used. For example, the usage of a vagus nerve of thalamic stimulator can reduce the frequency and severity of epileptic seizures

How does a vagus nerve stimulator work?

The Vagus Nerve Stimulator is inserted under the skin in the upper left breast area and connected to the vagus nerve at the neck by an electrode. The implantation is performed under general anaesthesia and takes about 1hour. After surgery, a longer hospital stay is usually not necessary.  As a pulse-emitting and battery-powered device, the VNS has certain similarities to a pacemaker. The batteries should be replaced after about 7-10 years.  At regular 5-minute intervals, the VNS generates electrical stimuli that are transmitted to the brain. Depending on the tolerance and effect on the frequency of epileptic seizures, the strength of the stimulation is individually adjusted over months.   You can also activate the stimulator yourself. For this purpose you will receive a magnet with which you can trigger an additional and more intensive stimulation. For example, if you perceive an aura, you can reduce the spread of epileptic activity. Or relatives can trigger a stimulation if they notice early signs of a seizure.

What influence does the stimulation have on my epileptic seizures?

The effectiveness of vagus nerve stimulation has been scientifically proven. However, it should be stressed that in most cases it is not possible to achieve freedom from seizures, but instead a reduction in the frequency or severity of epileptic seizures. However, not all patients benefit from this treatment. In up to 50% of patients, success can be achieved with the VNS. This positive treatment effect usually lasts over many years.

Other positive aspects of vagus nerve stimulation: 

• alertness is favourably influenced
• mood is often improved (for some years now, VNS has also been used primarily for the treatment of depression)
• many patients report an improved quality of life early in the course of treatment

Regarding side effects, many patients report hoarseness during stimulation. Generally, however, this is not perceived as disturbing. If necessary, the stimulator can be temporarily inactivated. Other side effects may include pain in the larynx and difficulty swallowing. Overall, the stimulator is well tolerated. Hardly any patients wish to terminate the treatment due to side effects. Furthermore,  side effects do not add up with medical adverse effects.

Is vagus nerve stimulation an option for me?

If your epilepsy cannot be controlled by medication and epilepsy surgery is no option, vagus nerve stimulation is a possible treatment alternative for you. This must be discussed in detail with your  physician. Rare reasons for exclusion can be cardiac disease, swallowing disorders, lung diseases or a stomach ulcer requiring treatment.

The ketogenic diet has been established for decades in the treatment of epilepsy. It is a very high-fat and low-carbohydrate diet. It is particularly suitable for children with difficult to control. Epilepsy. The ketogenic diet is mainly used as an adjunctive therapy in addition to medical treatment, but there are also patients who are treated exclusively with it, depending on the type of epilepsy and frequency of seizures. The goal is to reduce the severity and frequency of epileptic seizures and to reduce the drug load. In addition, there are other factors that improve the overall quality of life: some children show improved cognitive development under the ketogenic diet or have improvements in mood.

Since the change of diet is especially significant in the first few weeks, the introduction takes place under the supervision of experienced pediatricians and the nutritionists of the pediatric clinic as in-patients. Later, the diet can be continued independently by the parents. With a lot of ideas, the diet can be made very tasty and varied. Our experience has shown, the better the patients and parents are prepared, the better the ketogenic diet will go. Therefore, good cooperation with patients and parents is crucial.