Treatment of Epilepsy

Treatment of Epilepsy Treatment of Epilepsy The neurology team will design a treatment plan according to medical condition, state of health and individual needs. They may also refer to additional doctors or other medical professionals. Most medical treatments can involve some risks or complications. The neurologist will explain any possible risks or complications involved. Don’t be afraid to ask the doctors, nurses or therapists about your treatment. Drug Therapy Medication In many cases, seizures can be successfully prevented with medications. The type of medication you will receive depends on many factors. Your neurologist will explain how the medication should be taken and the side effects that may occur. Over a period of time medication regimen may be changed. It is very important that you take the medication exactly as directed. Call your neurologist if you have any questions about the medications or you experience some unexpected side effects. Some patients do not respond to medications and continue having seizures. In these cases, other treatments may be recommended. The standard treatment for epilepsy is the regular use of one or more chemical substances called anti–epileptic or anti–convulsant drugs. The ideal situation is when a person takes as little medication as possible while maintaining seizure control. Anti–epileptic drugs like phenytoin sodium, phenobarbitone, benzodiazepines are commonly used to control epilepsy. However the blood levels of these medicines need to be closely monitored so that adequate levels are constantly maintained. The most commonly used treatments are probably Dilantin, or Eptoin, Carbamazepine or Tegreto, and Phenobarbital, an older medication. The 1st two drugs are, in general well tolerated. Dilantin, is very effective as it is long acting and needs to be taken only once a day, the side effects are mostly cognitive and can cause problems with thought and memory, can lead people to tire easily and cause a kind of rash. Since it has been around for a long time it has been well researched and we are aware of its uses and limitations. The most common medication worldwide for seizures is Tegreto or carbamazepine. Chemically, it is very similarly to Dilantin but taken twice a day. But it is a different drug. The side effects are a bit different. If the dose is too high it can cause sedation and double vision. Drug options Over the past decade there have been a number of developments, with new more specific drugs becoming available. This is not to say that the older drugs have become obsolete. In fact, the newer preparations may not be at all suitable for some people. Each drug has two names, the generic, or chemical name (for example carbamazepine) and the trade name (for example Tegretol), given by the manufacturer. It is helpful for a person to know the generic names of his/her drugs, especially when travelling abroad. Team work Co–operation between you and your doctor is essential in establishing optimum control of your epilepsy. The more accurately you, or a family member, can describe your seizures and the effects of the medication, the more precise the doctor’s prescription can be. It is important that drugs are taken exactly as prescribed. Compliance is a major factor in the overall results that can be achieved. Your pharmacist is also able to assist with information and advice about your medication. Side–effects Like all drugs, anti–convulsants may have some side–effects. The appearance of these depends on each person’s individual response to the drug as well as how much of it he or she is taking. With only a few exceptions, side–effects associated with anti–convulsants drugs are mild and usually occur at the beginning of therapy, usually disappearing as the person becomes used to the drug. If side–effects do occur, they should be reported. Depending on the type of drug involved, the most frequent side–effects are drowsiness, irritability, nausea, rash, thickening of facial features, increase in body hair, physical clumsiness, overgrowth of gum tissue, and hyperactivity in children. Some drugs may produce emotional changes; occasionally a drug will actually increase rather than decrease the number of seizures a person experiences. However, many people are able to take the medication for years without experiencing any of these effects. Ketogenic Diet Special high–fat, low–protein, no–carbohydrate diet has been recommended for people with epilepsy who do not respond to medications. The diet mimics certain effects of starvation, which helps to prevent seizures. Dietician can help you to incorporate this diet into your family’s lifestyle. Strict adherence to the diet is essential for the treatment to be successful. Surgery for Epilepsy If seizures are confined to a part of the brain or if they are due to growths, surgical resection may cure the condition. Surgery helps lessen seizures after they’ve been on a couple of medications. Medications just suppress epilepsy, while surgery can be a cure. The best cases for surgery are patients with temporal lobe epilepsy. The temporal lobe lies next to the ear and can be removed without any effects that we are aware of. Conclusive testing is required before the person goes for surgery, as to define the exact area in the brain that is causing the seizures and that area is not important for other functions. Many of the patients don’t need to take anti–epileptic medications after surgery What are the surgical treatments for Epilepsy? Standard surgical procedures If drug therapy fails to control seizures, particularly partial, over a two or three year period, surgery may be appropriate. Children and young adults are the preferred candidates, because older people have more difficulty with rehabilitation. Tests for Surgical Decision Making. Advances in imaging and monitoring, new surgical techniques, and a better understanding of the brain and epilepsy in infants as well as in older individuals have made surgery a more viable option than in previous decades. The general approach is first to locate the brain tissue that triggers the epileptic event using long term EEG monitoring, usually with added information from imaging techniques, such as MRI or PET scans. If such tests detect a specific area in the brain as the location for the seizure, then surgery is possible. The physician then tries to determine if the offending nerve cells perform vital functions usually with the use of advanced MRI techniques. The surgeon’s goal is to remove just enough damaged tissue and no more in order to prevent seizures and limit brain injury. If the diagnostic tests indicate that more than one site is involved or they have conflicting results, then more invasive monitoring of the brain is required. Surgical procedures may be considered to prevent seizures. These procedures include: Disconnection procedures – These procedured disrupt abnormal electrical activity that occurs in the brain and triggers epileptic seizures. Two types of disconnection operations are: Corpus callostomy – Used to stop atonic and tonic seizures. Multiple subpial transections – Used when seizures are caused by parts of the brain that can’t be removed. Focal resections – Focal resections are the most common surgical approach for treating epilepsy and provide the best chance for patients to gain complete seizure control. These procedures involve the removal of a small area of the brain where seizures originate. New brain monitoring techniques allow doctors to better pinpoint brain tissue causing seizures. {jumi usermod/ads/ads.php}{/jumi} Types of resections include • Temporal lobectomy – A portion of the temporal lobe is removed to control seizures. • Lobar resection – A portion of a seizure, producing lobe, frontal, parietal or occipital lobe – is removed, if it can be done without damaging vital functions. • Hemispherectomy – One sphere of the brain is removed or disabled. The remaining half of the brain takes over many of the functions of the half that was removed. This procedure is used to treat severe conditions that have not responded to other treatments. • Gamma Knife radiosurgery – The Gamma Knife delivers a finely focused, high dose of radiation to remove tissue without damaging surrounding tissue. Some types of seizures, such as gelastic seizures which are accompanied by brief, sudden bursts of emotion, can be treated with this technology. • Vagus nerve stimulation – This procedure involves minor surgery and is a relatively new treatment that helps prevent or lessen the severity of seizures. An electrical stimulator is implanted that sends regular electrical pulses through the vagus nerve to the brain to reduce the onset or frequency of seizes. If a seizure occurs between doses of current, you or your child can pass a magnet over the device to trigger an additional dose. A child with a vagus nerve stimulator continues to take medication but sometimes can reduce the amount or number of medications. This procedure can treat a wide variety of seizure disorders when surgery isn’t an option. Prevention and Follow–Up To help cope with epilepsy and reduce your chance of injury from seizures, doctors recommend the following • Patient should carry identification, that indicates he or she has epilepsy. In an emergency, this information can ensure that you receive the right care. • Explain to your family, friends, teachers, relatives and sports coaches how to care for you if he or she has a seizure. • If you get regular or even occasional seizures, make sure he or she avoids dangerous situations and activities. Eg. Be careful when playing sports and should not swim unattended. • Should never stop taking seizure medication or change the amount taken without discussing it with a doctor first. • Always consult your doctor or pharmacist before taking other medications in addition to seizure drugs Medication for Epilepsy Epilepsy cannot be ‘Cured’ with medication. However, various medicines can control the seizures by stabilising the electrical activity of the brain. The success in controlling seizures by medication varies depending on the type of epilepsy. If there is no underlying cause for your seizures – Idiopathic epilepsy, you have a good chance that medication can fully control your seizures. Seizures caused by a core brain problem may be more difficult to control. Your physician will take into account various conditions, such as your age, type of epilepsy, other medicines you may be taking, possible side–effects, if you are pregnant, etc while choosing your medication. There are some popular medicines for each type of epilepsy and if one does not suit you, another may be better. Doctors usually start at the lowest possible dose to control seizures. The dose is usually increased if you have further seizures. Medicines are available as tablets, soluble tablets, capsules, or liquids. Side–effects of Epilepsy Medications Most medicines have probable side–effects, not everyone is effected. The listed of side–effects are found in the which comes in the medicine box. You should read this even though it may appear alarming. Many of the side–effects listed, are rare. When you start medication, don’t forget to ask your doctor about any problems that may arise for that particular medicine. Do not stop taking a medicine suddenly, if you notice a side–effect, but consult your doctor for advice. One of the common side–effect is sleepiness but eases or goes once the body gets used to the medicine. Side–effects which are rare, but you still need to be aware of are rashes or bruising whilst taking certain medicines. Re–occurring Seizures In some cases, seizures are not controlled immediately in spite of taking medicine. This could be because the dosage or timing of the medication needs re–assessing. A common cause of seizures is taking medication incorrectly. If you have taken a medicine correctly up to its maximum allowed dose, but it has not worked well, you may be advised to switch to a different medicine. If that does not work alone, taking two medicines together may be advised. It is quite uncommon that seizures are not controlled with two medicines. Importance of correct medication It is important to take your medicine as prescribed. Try to get into a daily routine. Forgetting an occasional dose is not a problem for some people, but for others would lead to breakthrough seizures. One of the reasons why seizures recur is due to not taking medication properly. Duration of Epilepsy Medication The chance of seizures recurring is higher for some types of epilepsy than others, only your doctor will be able to advise you, so follow his instructions religiously. You may be able to stop medication if your seizures have been well controlled for two or more years. Since there are many different types of epilepsy, some of which are age dependent may not need medication for long, but there are others that will need medication for life. Your life circumstances may influence the decision about stopping medication. If a decision is made to stop medication, it is best done gradually, reducing the dose over a period of several weeks or months. Follow the advice given by a doctor. How effective is Medication used for Epilepsy? The success in controlling seizures by medication varies depending on the type of epilepsy. For example, if no underlying cause can be found for your seizures you have a good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control. The following figures are based on studies of people with epilepsy which looked back over a five year period. These figures are based on grouping people with all types of epilepsy together which gives an overall picture. 1. About 5 in 10 people with epilepsy will have no seizures at all over a five year period. Many of these people will be taking medication to control seizures. Some will have stopped treatment having had two or more years without a seizure whilst taking medication. 2. About 3 in 10 people with epilepsy will have some seizures in this five year period, but far fewer than if they had not taken medication. 3. In total, with medication about 8 in 10 people with epilepsy are well controlled with either no, or few, seizures. 4. The remaining 2 in 10 people experience seizures, despite medication. Which Medicine is the most Suitable? A doctor will take into account various things when choosing a medicine to prescribe. These include: your type of epilepsy, age, other medicines that you take, possible side–effects, pregnancy, etc. There are popular medicines for each type of epilepsy. However, if one medicine does not suit, another may be better. A low dose is usually started. The aim is to control seizures at the lowest dose possible. If you have further seizures, the dose is usually increased. There is a maximum dose allowed for each medicine. In about 7 in 10 cases, one medicine can control all, or most, seizures. Medicines may come as tablets, soluble tablets, capsules, or liquids to suit all ages. What if Seizures still occur? In some seizures are not controlled despite taking one medicine. This may be because the dosage or timing of the medication needs re–assessing. A common reason why seizures continue to occur is because medication is not taken correctly. If in doubt, your doctor or pharmacist can offer advice. If you have taken a medicine correctly up to its maximum allowed dose, but it has not worked well, you may be advised to try a different medicine. If that does not work alone, taking two medicines together may be advised. However, in about 2 in 10 cases, seizures are not well controlled even with two medicines. When is Medication Started? The decision when to start medication may be difficult. A first seizure may not mean that you have ongoing epilepsy. A second seizure may never happen, or occur years after the first. For many people, it is difficult to predict if seizures will recur. Another factor to consider is how severe seizures are. If the first seizure was severe, you may opt to start medication immediately. In contrast, some people have seizures with relatively mild symptoms. Even if the seizures occur quite often, they might not cause much problem, and some people in this situation opt not to take any medication. The decision to start medication should be made by weighing up all the pros and cons of starting, or not starting, treatment. A popular option is to ‘wait and see’ after a first seizure. If you have a second seizure within a few months, more are likely. Medication is commonly started after a second seizure that occurs within 12 months of the first. However, there are no definite rules and the decision to start medication should be made after a full discussion with your doctor. What about side–effects? All medicines have possible side–effects that affect some people. All known possible side–effects are listed in the leaflet which comes in the medicine packet. If you read this it may appear alarming. However, in practice, most people have few or no side–effects, or just minor ones. Many side–effects listed are rare. Each medicine has it’s own set of possible side–effects. Therefore, if you are troubled with a side–effect, a change of medication may resolve the problem. When you start a medicine, ask your doctor about any problems which may arise for your particular medicine. Two groups of problems may be mentioned. 1. Side–effects which are relatively common, but are not usually serious. For example, sleepiness is a common side–effect of some medicines. This tends to be worse when first started. This problem often eases or goes once the body gets used to the medicine. Other minor side–effects may settle down after a few weeks of treatment. If you become unsteady, it may indicate the dose is too high. 2. Side–effects which are serious, but rare. Your doctor may advise what to look out for. For example, it is important to report any rashes or bruising whilst taking some types of medicine. Do not stop taking a medicine suddenly. If you notice a side–effect, ask your doctor for advice. Taking your Medication Correctly It is important to take your medicine as prescribed. Try to get into a daily routine. Forgetting an occasional dose is not a problem for some people, but for others would lead to breakthrough seizures. One of the reasons why seizures recur is due to not taking medication properly. A pharmacist is a good source of advice if you have any queries about medication. Some medicines taken for other conditions may interfere with medication for epilepsy. If you are prescribed or buy another medicine, always remind your doctor or pharmacist that you take medication for epilepsy. Even things such as indigestion medicines may interact with your epilepsy medication, which may increase your chance of having a seizure. Some epilepsy treatments interfere with the contraceptive pill. You may need a higher dose pill for effective contraception. Your Family Planning doctor will be able to advise you about this. What about Epilepsy Medication and Pregnancy? Being pregnant does not usually make epilepsy any better or worse. However, there is a small chance that the unborn child may be affected by some medicines used to treat epilepsy. Before becoming pregnant it is best to seek advice from a doctor, epilepsy nurse, or counsellor. The potential risks can be discussed. One important point is that you should take extra folic acid before becoming pregnant, and throughout the pregnancy. This may reduce the chance of certain abnormalities occurring. If you have an unplanned pregnancy, do not stop epilepsy medication which may risk a seizure occurring. See a doctor as soon as possible. How long do I need to take Medication for? You may wish to consider stopping medication if you have not had any seizures for two or more years. It is important to discuss this with a doctor. The chance of seizures recurring is higher for some types of epilepsy than others. Overall, if you have not had any seizures for 2–3 years and you then stop medication: • About 6 in 10 people will remain free of seizures two years after stopping medication. If seizures do not return within two years after stopping medication, the long–term outlook is good. However, there is still a small chance of a recurrence in the future. • About 4 in 10 people will have a recurrence within two years. There are many different types of epilepsy, some of which are age dependent, but some that will need medication for life. Your epilepsy specialist should be able to offer you more advice about the long–term outlook for your particular type of epilepsy. Your life circumstances may influence the decision about stopping medication. If a decision is made to stop medication, it is best done gradually, reducing the dose over a period of several weeks or months. Follow the advice given by a doctor. Are there any other Treatments for Epilepsy? Surgery to remove a cause of seizures in the brain is an option in a small number of cases. It may be considered when medication fails to prevent seizures. It is only possible for certain causes in certain areas of the brain. Therefore, only a small number of people are suitable for surgery. Also, there is risk involved in brain surgery. However, techniques continue to improve and surgery may become an option for more and more people in the future. The ketogenic diet, a diet that needs to be supervised by an experienced dietician, is useful for some children and adults with particular types of epilepsy. Vagal nerve stimulation is another treatment that is occasionally used in some cases. Complementary therapies such as aromatherapy may help with relaxation and relieve stress, but have no proven effect on preventing seizures. Counseling – Some people with epilepsy become anxious or depressed about their condition. A doctor may be able to arrange counseling with the aim of overcoming such feelings. Genetic counseling may be appropriate if the type of epilepsy is thought to have a hereditary pattern. It may be an option to consider before starting a family. Book