ABOUT EPILEPSY - TREATMENTS

Is there a cure for Epilepsy?

There is no known "cure" for Epilepsy. Medications can often control seizures, but they are not a cure. Some forms of Epilepsy occur only in childhood, and the person is said to have outgrown the seizures. In some cases there is a spontaneous remission of the seizure disorder. Sometimes, surgery to remove the part of the brain in which the seizures originate can produce a complete and permanent stop to seizures.

Is it fatal?

Epilepsy itself can cause death if prolonged repeated seizures ("status epilepticus") are not treated properly. Such deaths are very rare, however. More common is death due to hazards or accidents that occur when someone has a seizure unexpectedly in a potentially dangerous situation.

What kinds of treatments are available?

When a physician diagnoses Epilepsy, a specific treatment can be recommended. The treatment prescribed by the physician is designed to control the seizures and help the patient to carry on a healthy life, participating in all normal activities, including most sports. The two major kinds of treatments are drug therapy and surgery.

Are there drug treatments for Epilepsy?

Treatment of Epilepsy is primarily through the use of special anti-convulsive drugs. There are many different types of these drugs, and the type prescribed will depend upon the particular needs of the individual. The drugs are prescribed either alone or in a combination. The various drugs or combination of drugs control different types of seizures.

How do drugs work to control seizures?

The drugs used to control seizures are called anticonvulsants. How they stop the seizures, change the seizure threshold, or prevent electrical discharges from occurring is not fully known. The neurochemical basis for their action is also unknown. Research has shown that some of the drugs can block the spread of abnormally fast nerve impulses in the brain, while others can increase the flow of chloride ions, which stabilize the nerve cells. Research is still being done in this area.

What drugs are used to treat Epilepsy?

There are many different drugs used to treat Epilepsy. Some of the more common ones are: Tegretol (carbamazepine), Dilantin (phenytoin), Mysoline (primidone), Epival (valproate), Frisium (clobazam), Rivotril (clonazepam), Mogadon (nitrazepam), Phenobarbitol, Depakene (valproic acid), Zarontin (ethosuximide), Neurontin (gabapentin), Lamictal (lamotrigine), Sabril (vigabatrin). There are also many new drugs under development.

The choice of drug is determined by the type of seizure, the side effects of the drugs, and the age and health of the person. Often a number of drugs, and combinations of drugs, have to be tried until the seizures are brought under control.

How effective are the drug treatments?

Most epileptic seizures are controlled by special anti-convulsive drugs prescribed by a physician. About 50 per cent of those who take this medication will have their seizures eliminated; 30 per cent will have their seizures reduced in intensity and frequency to the point where they can live and work normally. The remaining 20 per cent are either resistant to the medication, or else they require such large dosages of the drug to control the seizures that it is preferable to accept partial control.

Do these drugs have side effects?

DO NOT discontinue your medication without discussing it with your physician first.

Many medications for Epilepsy have side effects. These can range from mild to severe, and will differ depending on the drug and dosage. Some of the more common side effects of anti-epileptic drugs are: drowsiness, dizziness, nausea, irritability, and hyperactivity. Side effects vary according to each medication. Typical side effects include dizziness, weight gain or loss, drunkenness feeling, nausea, fatigue. Other side effects which can be more serious but usually less frequent are gum swelling or discoloration, hair loss, aplastic anemia, and hepatic failure. Your physician will discuss the side effects with you when he prescribes a medication. Your pharmacist also will have special package inserts outlining the possible side effects to your medication. Should you have concerns or questions regarding your medication be sure to contact your physician. Do not stop taking your medicine.

What is a "blood level"?

"Blood level" refers to the amount of anticonvulsant in the blood. It is measured with a simple blood test and is used to help determine if a patient's symptoms may be due to toxicity or to side effects of medication. It is also used to determine if the patient is taking enough medication to prevent seizures. The therapeutic range for different anti-convulsants has been determined by testing blood levels in thousands of patients whose seizures are controlled and who are not experiencing toxic effects.

What are the symptoms of too high a drug level?

Too high of a drug level may cause a person to experience side effects such as drowsiness, confusion, breakthrough seizures, unsteadiness, and nausea. This may require a reduction in dosage or a change to a different medication.

How much do the drugs cost?

The cost of the anticonvulsant drugs will depend on the dosage levels needed, the drug being used, and the amount in each prescription. There is usually a difference in price between a drug's brand name and its generic equivalent. Ask your doctor or pharmacist if a generic one is available for you to use, and if it is appropriate.

Is it necessary for all people with Epilepsy to be on medication?

Treatment of Epilepsy is primarily through the use of anticonvulsive drugs. There are many different types of drugs and the type prescribed will depend upon the particular seizure pattern of the individual. If someone has been seizure free for several years, the doctor may decide to slowly withdraw the medication.

When is surgery used to treat Epilepsy?

This only can be determined after a comprehensive epilepsy evaluation. Each patient's condition varies and it is difficult to say whether surgery can help you without a comprehensive epilepsy evaluation conducted by a neurologist who specializes in epilepsy (an epileptologist). Outcome data from the Epilepsy and Brain Mapping Program at Good Samaritan Hospital in Los Angeles indicate that more than 83 percent of patients undergoing temporal resections are seizure-free and the conditions of more than 97 percent are markedly improved. In frontal lobe epilepsy, seizures are markedly reduced in more than 85 percent of patients undergoing resections. Surgery is used only when medication fails and only in a small percentage of cases where the injured brain tissue causing the seizures is confined to one area of the brain and can be safely removed without damaging personality or functions. Learn more about this topic.

What is the likelihood that my child will outgrow a seizure disorder?

The likelihood of a child outgrowing a seizure disorder is difficult to answer. Sometimes children do outgrow Epilepsy, while for others the seizures may stay the same or intensify with age. Some people experience the same type of seizures throughout their lifetime. Some epilepsies are known to almost always remit (for example, Benign Rolandic Epilepsy or Epilepsy with centrotemporal spikes and rolandic seizures), some are known to usually remit (e.g., childhood absence) and some are known to almost never remit (e.g., Juvenile Myoclonic epilepsy). The medical community cannot predict who will continue to have seizures and who will not, but they feel that the sooner Epilepsy is diagnosed, the better it can be controlled.

Do non-traditional approaches help?

Some people with Epilepsy have tried many different approaches to improve their seizure control. In some cases, the person feels that they have experienced improvement. However, scientific studies have not been conducted into most non-traditional approaches. Techniques known to reduce stress or improve overall health may be helpful to some people. Other techniques that have been tried are biofeedback, diets, acupuncture, and meditation.

Does transcendental meditation have any effect on Epilepsy?

The medical community has not determined if things such as transcendental meditation have any real effect on Epilepsy. It has been shown that when people know what is happening at a given moment, some can influence the automatic processes of the body. With biofeedback, some people can moderate and possibly change certain functions thought to be involuntary, such as the rhythm of their brain waves, blood pressure, heart rate, etc. The significance of this for Epilepsy is not known.
Does biofeedback help?

Biofeedback is the process of moderating, limiting or changing certain physiological functions previously thought to be involuntary, such as heart rate, blood pressure, brain waves, etc. For Epilepsy, a person could be given extensive biofeedback training and taught behavioral modification techniques through which he/she control certain physiological functions related to seizures. Biofeedback training can also be taught as a method of stress reduction. This in itself can reduce the frequency of seizures in some persons with stress related seizures. Further study is needed to ascertain the value of biofeedback in the treatment of Epilepsy. Non-medical approaches may improve seizure control in some persons, but should not be undertaken without the knowledge of the physician prescribing the anti-convulsants. Under no circumstances should anti-convulsants be stopped suddenly as this may precipitate prolonged and life-threatening seizures.

Is there a special diet for people with Epilepsy?

Good nutritional habits and a healthy life style may assist in the maintenance of optimum seizure control. Experiencing a drastic weight change may mean that either a chemical or metabolic imbalance is occurring, and you should consult your physician. Though some anti-convulsants may cause nutrient deficiencies in some people, a well balanced diet will usually prevent this.

What is a ketogenic diet?

A ketogenic diet is very rich in lipids (fats) and oils, but low in proteins and carbohydrates. This unusually high intake of lipids and oils creates a condition in the body know as "ketosis". The metabolic shift that is created may increase the seizure threshold. Ketogenic diets are not frequently used for seizure control because it is difficult to maintain the ketosis, and other health risks can be associated with high levels of fats and oils. Strict medical supervision is required when using this as a therapy.