Seizure Management Technology Through the Years

From early surgical procedures and the invention of the EEG to modern medications and wearable seizure monitors, technology has transformed how epilepsy is understood, diagnosed and managed. Take a journey through the remarkable developments that have helped shape epilepsy care over the years.

The Beginnings of Seizure Management

Seizure management technology is a vast field of continuously developing research. These developing technologies range from specialised diagnostic equipment to devices that help people manage their condition. Epilepsy has been around as long as humanity has, with one of the earliest records of it dating from 2,000 B.C. In fact, ancient medical books even described some of the first neurosurgery procedures in the hopes of epilepsy treatment. Before modern medicine made advancements, seizures were often thought to be associated with divine superstition such as demonic or ghostly possession. However, in the late 18^th century, advancements in anatomy and science began to shape our view of epilepsy into what we know today: epilepsy is a neurological disorder, which means it impacts the brain.

The Advancement of Surgery

At the beginning of the 20^th century, Walter Dandy introduced a procedure called the “anatomical hemispherectomy”, which involved completely removing one side of the brain to try and stop severe cases of epilepsy. Hemispherectomies are rarely practiced today, but rather than physically removing half of the brain, surgeons only disconnect some of the neural pathways responsible for movement.

This anatomical hemispherectomy method was quickly outpaced by other surgical methods which instead focused on finding specific places in the brain where the abnormal electrical signals are. One of these techniques, called the “Montreal Procedure” involved using electrical probes on a conscious patient and having them describe the feelings these electrical signals presented. This allowed the surgeons to identify the exact region of the brain where the abnormal electrical activity was coming from. This procedure led to a phenomenal exploration of the structural organisation of the brain – leading to what we now call the homunculus. The homunculus is a map of how our brain senses our body and is so detailed that it is still used to teach anatomy today.

The EEG

One of the biggest advancements in how we diagnose and treat epilepsy came with the invention of the electroencephalogram (EEG) in 1924.  An EEG, first developed by a man named Hans Berger, measures the electrical impulses in the brain by placing sensors on the outside of the skull. The EEG became instrumental in guiding epilepsy surgeries in the 1950’s, allowing specific parts of the brain to be localised instead of severing whole lobes or hemispheres. This idea of localising seizures became increasingly precise throughout the later 1900s, resulting in a procedure called stereoelectroencephalography (SEEG). This minimally invasive surgical procedure places electrodes in deep parts of the brain to record seizures more accurately. This surgery, along with EEGs are still used today for the detection of seizures and the diagnosis of epilepsy.

Medications

Herbal remedies were still commonly used in epilepsy until the mid-1800s when it was discovered that potassium bromide had anticonvulsant properties. Potassium bromide was not a catch all solution though, as it had severe side effects such as extreme sleepiness and behavioural aggression. This treatment was used for over 70 years when the discovery of other drugs pushed it out of use (mainly phenobarbital and phenytoin). During the late 20^th century, a boom of different pharmaceuticals began appearing on the market, targeting different types of seizures in different ways, resulting in more choice for people with epilepsy.

Home Epilepsy Devices

Epilepsy technology isn’t just medication and surgery. Many devices have been invented to help with safety, comfort or monitoring of seizures in the home. Epilepsy safe beds were made and used in England during the early 20^th century — their large sides help to keep the person from falling out of bed during a seizure. During this time there was no real way of monitoring seizures at home except for the memory of the person or caregiver. Modern technologies changed this.

In the late 1990s home bed monitors became available.  These beds have sensors in them that detect the convulsive movements of certain seizures, allowing them to be recorded. Over recent years, wearable technology has been made for at-home seizure detection, as well as fall detection devices, and overnight monitoring with recording capability.  These devices not only detect seizures but can also call caregivers if a seizure is detected. You can find out more about these devices in this fact sheet.

It is incredible to see how technology has evolved over the years to help diagnose, treat and monitor epilepsy and seizures. These technologies and advancements improved our understanding of not only epilepsy, but also the entirety of the human brain.

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