Epilepsy Medication
Most people with epilepsy are treated with antiepileptic drugs. Over the last decade many drugs have entered the market that are more affective and have less side effects. People respond differently to these drugs depending on the type of epilepsy they have. If the wrong antiepileptic drug is used it can actually increase seizure activity therefore getting a proper diagnosis is extremely important.
People with generalized seizures tend to have positive responses to the following drugs:
- Valproic acid (Depakote/Depakene)
- Lamotrigine (Lamictal)
- Topiramete (Gabitril)
- Zonisamide (Zonegram)
People with partial seizures tend to have positive responses to the following drugs:
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin)
- Valproic acid (Depakote/Depakene)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Tiagabine (Gabitril)
- Levatiracetam (Keppra)
- Zonisamide (Zonegram)
Most people will see significant improvement by taking one anti-epileptic drug but some have to take two or more medications to reduce seizure activity. When multiple anti-epileptics are used there are many possible interactions so it is important that the doctor is experienced with administering multiple drugs.
If is difficult to know how someone will be affected by ani-epileptic medications and some experimentation with multiple drugs is common.
If anti-epileptic drugs do not work the first step is to do further testing to make sure the person is not misdiagnosed. In this case EEGs and brains scan are common diagnostic tools. In some cases it is determined that the seizure activity is not epileptic in nature and different measure must be considered.
In some cases, even with the appropriate diagnosis, people don’t respond to medication. In this case there are other treatment options.
Other treatment options include:
- Experimental anit-epileptic medications
- The ketogenic diet
- The vagus nerve stimulator
- Epilepsy surgery
Experimental anti-epileptic medications
Drugs are available at various epileptic centers that have not yet been approved by the Food and Drug Administration (FDA). If approved for the study she will be required to perform certain functions such as filling out questionnaires, having regular blood work done and so on.
Ketogenic diet
The Ketogenic diet consists of foods rich in fat and low in carbohydrates and proteins. Most people are not able to reduce their seizure activity with this diet, but this treatment options has proven to be affective for children with a condition known as Lennox-Gastaut Syndrome. The problem with this method it is difficult for parents to make sure their child adheres to the diet.
Vagus Nerve Stimulator
This treatment option requires a wire to be wrapped around the vagus nerve in the neck and a pacemaker like device implanted under the skin below the collarbone. This device fires an electric shock via a magnet and can reduce the frequency and severity of seizures.
Epilepsy surgery
The goal of epileptic surgery is to remove the part of the brain that is causing the seizures. For epileptic surgery to be considered the seizure activity of the patient must originate from one location in the brain and that part must not control any vital functions such as speech or movement. If a video EEG proves that the seizure activity originates from an isolate area of the brain than surgery is an option.
In some cases patients will have seizures that appear to come from one part of the brain but the exact location is it is difficult to pinpoint. In this case additional testing is required.
Three types of imaging studies are often used to determine if surgery is a viable option:
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomography (PET)
- Single Photon Emission computed Tomography (SPECT)
Magnetic resonance imaging helps visualize abnormalities. These abnormalities can be focal lesions like tumors, strokes, damage from head injuries and developmental issues. There are parts of the brain that are more likely to be epileptic than others and therefore they are checked more carefully. For example, the hippocampus of the temporal lobe is often epileptogenic in nature.
Other tests are used like the Positron emission tomography that helps visualize the metabolic activity of the brain. The single photon emission computed tomography tests the rate at which blood perfuses regions of the brain.
Types of surgery available
1.Standard Temporal lobectomy. This procedure is for patients with unilateral mesial temporal lobe epilepsy. Patients end up seizure-free in 80% to 90% of the time.
2.Corpus callosotmy . A corpus callosotomy involves cutting the corpus callosum, the fiber bundle connecting the two sides of the brain. This procedure does not require removing any brain tissue. Instead, it often requires cutting the front two-thirds of corpus callosum (a "partial callosotomy") with the goal of reducing seizure frequency. At times the other one-third is cut at a later date ("complete callosotomy"). On average Seizure frequency is reduced by 70% to 80% after partial callosotomy and 80% to 90% after complete callosotomy.
3.Hemispherectomy. This process involves disconnecting of one side of the brain from the other. This procedure is for patients who have seizures and lesions on the majority of one hemisphere of the brain. The chance of reducing seizures if very good.
4.Focal Brain resection of the epileptogenic tissue of neocortical origin. This procedure is performed on patients when the epilepsy originates in a portion of the brain outside the mesial temporal lobe. The chance of reducing seizures is very good.
Overcoming the stigma associated with Epilepsy can feel like a daunting challenge. Most people just don’t understand, even those who have the chance to get to know someone with epilepsy. Many believe that epilepsy is a form of mental retardation or illness and that those with epilepsy cannot be productive members of society. More educational programs are needed for the general public.
People with epilepsy who are treated can live a productive and happy life.