What Are the Treatments for Epilepsy?
The majority of epileptic seizures are controlled through drug therapy, particularly anticonvulsant drugs. The type of treatment prescribed will depend on several factors including the frequency and severity of the seizures as well as the person's age, overall health, and medical history. An accurate diagnosis of the type of epilepsy is also critical to choosing the best treatment.
Many drugs are available to treat epilepsy, several of which have only recently been released.
Older medications used to treat epilepsy include:
- Dilantin or Phenytek
- Tegretol or Carbatrol
- Depakote, Depakote ER
- Valium and similar tranquilizers such as Tranxene and Klonopin
Newer drugs to treat epilepsy include:
In general, for a given type of epilepsy there are only minor differences among appropriate drugs. The choice is most often based on other factors specific to each patient, such as which side effects can be tolerated by the patient, other illnesses they may have, and which delivery method is acceptable.
Although the different types of epilepsy vary greatly, in general, medications can control seizures in about 70% of patients.
Side Effects of Epilepsy Drugs
Before any epilepsy drug is prescribed, your health care provider will discuss with you the potential benefits, side effects, and risks.
As is true of all drugs, the drugs used to treat epilepsy have side effects. The occurrence of side effects depends on the dose, type of medication, and length of treatment. The side effects are usually more common with higher doses but tend to be less severe with time as the body adjusts to the medication. Anti-epileptic drugs are usually started at lower doses and increased gradually to make this adjustment easier.
There are three types of side effects:
Common or predictable side effects. These are generic, nonspecific, and dose-related side effects which occur with any epilepsy drug because it affects the central nervous system. These side effects include blurry or double vision, fatigue, sleepiness, unsteadiness, as well as stomach upset.
Idiosyncratic side effects. These are rare and unpredictable reactions which are not dose-related. Most often, these side effects are skin rashes, low blood cell counts, and liver problems.
Unique side effects. These are those that are not shared by other drugs in the same class. For example, Dilantin or Phenytek can cause the gums to swell and Depakene can cause hair loss. Your doctor will discuss any unique side effects before prescribing the medication.
How Long Epilepsy Treatment Lasts
In some types of epilepsy, patients can be taken off treatment after a few years, while other types of epilepsy require life-long treatment. With few exceptions, patients who are seizure-free for a certain period should be reevaluated to determine whether the drug can be discontinued. How long the seizure-free period should be varies among the types of epilepsy and is controversial even for a given type. The decision to discontinue a medication also depends on more than the length of the seizure-free period.
What is clear, however, is that epilepsy drugs should at least be considered for discontinuation in patients who are seizure-free for 10 years. If a medication is going to be discontinued, it should be weaned gradually to avoid triggering a seizure.
Surgery for Epilepsy
Most patients with epilepsy do not require surgery. However, if seizures are not controlled after a trial of two or three medications (usually accomplished within two years) then re-evaluation is suggested. This information is critical in deciding if epilepsy surgery is an option. Of the 30% of patients whose seizures cannot be controlled with drugs, approximately one third (more than 100,000 in the U.S.) may be candidates for epilepsy surgery. However, only about 3,000 epilepsy surgeries are performed annually.
Before surgery is considered, a comprehensive presurgical exam is performed. This evaluation is performed to ensure that the operation will likely improve the seizures and that it will not cause damage to essential functions such as speech and memory. The evaluation requires prolonged EEG-video monitoring and other tests to pinpoint the exact location of the injured brain cells causing the seizures. The location of the damaged cells determines whether the surgery can be performed and what technique should be used.
The multidisciplinary evaluation is directed by a neurologist specializing in epilepsy (an epileptologist). A patient's eligibility for surgery is determined jointly by the neurosurgeon, neuroradiologist, neuropsychologist, social worker, and epileptologist. The decision to have the surgery is made jointly by the patient and the epileptologist after carefully reviewing the risks and benefits of the procedure.
Surgery is most commonly performed to treat partial epilepsy, since only one area of the brain is involved. During surgery, the area of the brain that triggers the seizures (usually a portion of the anterior temporal lobe) is removed. After surgery, some patients will be completely free of seizures; in others, the seizures will be better controlled. A few patients may need additional surgery.
Other surgical approaches are reserved for specific types of epilepsy and are most often performed in young children. One approach is to remove a large part of one side of the brain (a hemispherectomy); another is to cut the nerve fibers connecting the two sides of the brain (a corpus callosotomy).
Other Epilepsy Treatment Options
The ketogenic diet has received much attention lately and is effective for treating certain types of epilepsy. Specifically, it is used most frequently in children with seizures that have not responded to medical therapy. However, the diet requires careful planning and may be difficult to follow, so it is usually not recommended in older children or adults. The diet is usually started in the hospital, and when successful, it is most often maintained for two to three years.
A relatively new treatment involves electrical stimulation of the vagus nerve. This treatment requires minor surgery to implant a stimulator, which is about the size of a silver dollar. The stimulator is placed under the skin in the upper chest, like a pacemaker. The treatment appears to be effective for seizures that do not respond well to medications alone. The degree of effectiveness of the vagus nerve stimulator is approximately the same as medication. Vagus nerve stimulation decreases seizure numbers by half or more in 40% to 50% of patients, but rarely eliminates all seizures. Almost all patients need to continue taking medications after the stimulator has been placed, although many people can take fewer drugs.
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Reviewed by Jon Glass on September 16, 2009