What is Epilepsy and what is the treatment for it?

2 Comments

1. ladyparrotluvr says:

   July 5, 2010 at 6:26 pm

   I developed epilepsy after a car accident. (Me vs deer, I lost) I searched the internet for any info I could find on types of seizures (there are many), causes, & the different meds. My best advice to you is go to. There you will find all kinds of info as well as links to other epilepsy sites. Also, there are various support groups with friendly & knowledgable people who have lived with the condition for a lot longer than I have. Good luck to you.
2. danielpsw says:

   July 6, 2010 at 2:25 am

   Epilepsy (sometimes referred to as a seizure disorder) is a common chronic neurological condition that is characterized by recurrent unprovoked epileptic seizures. It affects approximately 50 million people worldwide.[1] It is usually controlled, but not cured, with medication – although surgery may be considered in difficult cases.

   Treatment

   Epilepsy is usually treated with medication prescribed by a physician; primary caregivers, neurologists, and neurosurgeons all frequently care for people with epilepsy. In some cases the implantation of a stimulator of the vagus nerve, or a special diet can be helpful. Neurosurgical operations for epilepsy can be palliative, reducing the frequency or severity of seizures; or, in some patients, an operation can be curative.
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   Responding to a seizure

   In most cases, the proper emergency response to a generalized tonic-clonic epileptic seizure is simply to prevent the patient from self-injury by moving him or her away from sharp edges, placing something soft beneath the head, and carefully rolling the person onto his or her side to avoid asphyxiation. Should the person regurgitate, the material should be allowed to drip out the side of the patient’s mouth by itself. If the seizure lasts longer than 5 minutes, Emergency Medical Services should be contacted. Prolonged seizures may develop into status epilepticus, a dangerous condition requiring hospitalization and emergency treatment.

   Objects should never be placed in a person’s mouth during a seizure as this could result in injury to the person’s mouth or obstruction of the airway. Despite common folklore, it is not possible for a person to swallow their own tongue during a seizure.

   After a seizure, it is typical for a person to be confused, disoriented, and possibly agitated or sleepy. It is important to stay with the person until this passes; people should not eat or drink until they have returned to their normal level of awareness, and they should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure; this is not dangerous. In about 50% of people with epilepsy, headaches may occur after a seizure. These headaches share many features with migraines, and respond to the same medications.

   If it seems to have been a first seizure, it is likely to be noticeably helpful to make a written or otherwise recorded note of the sequence and nature of events. The doctor deciding on further management will probably find this helpful.
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   Pharmacologic treatment

   Some medications can be taken daily in order to prevent seizures altogether or reduce the frequency of their occurrence. These are termed “anticonvulsant” or “antiepileptic” drugs (sometimes AEDs). All such drugs have side effects which are idiosyncratic and others which are dose-dependent; it is not possible to predict who will suffer from side effects or at what dose the side effects will appear.

   Some people with epilepsy will experience a complete remission when treated with an anticonvulsant medication. If this does not occur, the dose of medication may be increased, or another medication may be added to the first. The general strategy is to increase the medication dose until either the seizures are controlled, or until dose-limiting side effects appear; at which point the medication dose is reduced to the highest amount that did not produce undesirable side effects.

   Serum levels of AEDs can be checked to determine medication compliance and to assess the effects of drug-drug interactions; serum levels are generally not useful to predict anticonvulsant efficacy in an individual patient, though in some cases (such as a seizure flurry) it can be useful to know if the level is very high or very low.

   If a person’s epilepsy cannot be brought under control after adequate trials of two different drugs, that person’s epilepsy is generally said to be ‘medically refractory.’

   Various drugs may prevent seizures or reduce seizure frequency: these include carbamazepine (common brand name Tegretol), clobazam (Frisium), clonazepam (Klonopin), ethosuximide (Zarontin), felbamate (Felbatol), fosphenytoin (Cerebyx), flurazepam (Dalmane), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), mephenytoin (Mesantoin), phenobarbital (Luminal), phenytoin (Dilantin), pregabalin (Lyrica), primidone (Mysoline), sodium valproate (Epilim), tiagabine (Gabitril), topiramate (Topamax), valproate semisodium (Depakote), valproic acid (Depakene, Convulex), and vigabatrin (Sabril).

   Other drugs are commonly used to abort an active seizure or interrupt a seizure flurry; these include diazepam (Valium) and lorazepam (Ativan). Drugs used only in the treatment of refractory status epilepticus include paraldehyde (Paral) and pentobarbital (Nembutal).

   Bromides were the first of the effective anticonvulsant pure compounds, but are no longer used in humans[6] due to their toxicities and low efficacy.
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   Surgical treatment

   Surgical treatment can be an option for epilepsy when an underlying brain abnormality, such as a benign tumor or an area of scar tissue (e.g. hippocampal sclerosis) can be identified. The abnormality must be removable by a neurosurgeon.

   Surgery is usually only offered to patients when their epilepsy has not been controlled by adequate attempts with multiple medications. Before surgery is offered, the medical team conducts many tests to assess whether removal of brain tissue will result in unacceptable problems with memory, vision, language or movement, which are controlled by different parts of the brain. These tests usually include a neuropsychological evaluation, which sometimes includes an intracarotid sodium amobarbital test (Wada test). Resective surgery, as opposed to palliative, successfully eliminates or significantly reduces seizures in about 50-90% of the patients who undergo it (the exact percentage depends on the particulars of the case in question.) Many patients decide not to undergo surgery owing to fear or the uncertainty of having a brain operation.

   The most common form of resective surgical treatment for epilepsy is to remove the front part of either the right or left temporal lobe. A study of 48 patients who underwent this operation, anterior temporal lobectomy, between 1965 and 1974 determined the long-term success of the procedure. Of the 48 patients, 21 had had no seizures that caused loss of consciousness since the operation. Three others had been free of seizures for at least 19 years. The rest had either never been completely free of seizures or had died between the time of the surgery and commencement of the study.[7]

   Palliative surgery for epilepsy is intended to reduce the frequency or severity of seizures. Examples are callosotomy or commissurotomy to prevent seizures from generalizing (spreading to involve the entire brain), which results in a loss of consciousness. This procedure can therefore prevent injury due to the person falling to the ground after losing consciousness. It is performed only when the seizures cannot be controlled by other means. Resective surgery can be considered palliative if it is undertaken with the expectation that it will reduce but not eliminate seizures.

   Hemispherectomy is a drastic operation in which most or all of one half of the cerebral cortex is removed. It is reserved for people suffering from the most catastrophic epilepsies, such as those due to Rasmussen syndrome. If the surgery is performed on very young patients (2-5 years old), the remaining hemisphere may acquire some rudimentary motor control of the ipsilateral body; in older patients, paralysis results on the side of the body opposite to the part of the brain that was removed. Because of these and other side effects it is usually reserved for patients who have exhausted other treatment options.
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   Other treatment

   Ketogenic diets may occasionally be effective in controlling some types of epilepsy; although the mechanism behind the effect is not fully understood, shifting of pH towards a metabolic acidosis and alteration of brain metabolism may be involved. Ketogenic diets are high in fat and extremely low in carbohydrates, with intake of fluids often limited. This treatment, originated as early as the 1920s at Johns Hopkins Medical Center, was largely abandoned with the discovery of modern anti-epileptic drugs, but recently has returned to the anti-epileptic treatment arsenal. Ketogenic diets are sometimes prescribed in severe cases where drugs have proven ineffective.

   There are several downsides to what initially seems a benign therapy, however. The ketogenic diet is not good for the heart or kidneys and medical problems resulting from the diet have been reported. In addition, the diet is extremely unpalatable and few patients are able to tolerate it for any length of time. Since a single potato chip is adequate to break the ketosis, staying on the diet requires either great willpower or perfect control of a person’s dietary intake. People fed via gastrostomy or young children who receive all their food in the presence of a caregiver are better candidates.

   Vagus nerve stimulation is a recently developed form of seizure control which uses an implanted electrical device, similar in size, shape and implant location to a heart pacemaker, which connects to the vagus nerve in the neck. Once in place the device can be set to emit electronic pulses, stimulating the vagus nerve at pre-set intervals and milliamp levels. Treatment studies have shown that approximately 50% of those treated in this fashion will show significant seizure reduction.

   Some people with epilepsy receive a special dog which has the rare talent of sensing the onset of a seizure and is trained to alert the human so they can reach a safe location before their seizure puts them in danger. Other epilepsy care dogs do not sense seizures, but serve as companions and guardians during the loss of consciousness accompanying a seizure.

   The Institutes for The Achievement of Human Potential promulgate a home program consisting of a healthy diet, clean air, and respiratory training. This alternative approach is regarded as dangerous and without value by most medical practitioners.

   Magnesium and vitamin B6 exerted a positive non-specific influence on the mental states of patients with epilepsy, depression and anxiety during an experiment.[8]

   A number of systematic reviews by the Cochrane Collaboration into treatments for epilepsy looked at acupuncture[9], psychological interventions[10], vitamins[11] and yoga[12] and found there is no reliable evidence to support the use of these as treatments for epilepsy.

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