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Epilepsy Topics

Epilepsy is a condition of recurring seizures. A seizure is an abnormal firing of cerebral neurons, which may or may not have a clinical manifestation. We are familiar with seizures, where people fall down and shake all over.

Epilepsy is not a single disorder, but covers a wide spectrum of problems characterized by unprovoked, recurring seizures that disrupt normal neurologic functions. Epileptic seizures occur when a group of nerve cells in the brain (neurons) become activated simultaneously, emitting sudden and excessive bursts of electrical energy. This hyperactivity of neurons can occur in various locations in the brain and, depending on the location, have a wide range of effects on the sufferer from brief moments of confusion to minor spasms to loss of consciousness.

The nerves themselves may be damaged or problems might occur in neurotransmitters (die chemicals that act as messengers between nerve cells). The neurotransmitter, gamma aminobutyric acid (GABA) seems to be particularly important in suppressing seizures. Experiments also suggest that deficiencies in a receptor of the neurotransmitter serotonin may help promote epileptic seizures.

Definition of Epilepsy Epilepsy can be defined as a group of disorders characterized by abnormal electrical activity in the brain leading to altered behavior which may manifest as a change in a person’s consciousness, movement, or actions. These physical changes are called epileptic seizures. Epilepsy is therefore sometimes called a seizure disorder. Epilepsy affects people in all nations and of all races at every age.

It must be emphasized that every seizure may not be an indication of an epileptic disorder. Many times young children with high fever go into convulsive seizures. These are called as febrile convulsions & do not occur throughout life. Similarly seizures caused due to metabolic imbalances, drug interactions or alcohol/narcotic withdrawals are also not classified as epilepsy. Moreover a single seizure does not mean that the person has epilepsy.

Classification

The two categories of seizures are generalized and partial. Generalized seizures result due to electrical impulses from the entire brain. Partial seizures are caused by activity in a portion of the brain. The part where a seizure is triggered is called the seizure focus.

Partial Seizures

Partial means that the electrical discharge starts focally at one point in the brain, eg., the left hippocampus. If the seizure spreads to other areas of the brain, but does not interfere with consciousness, then it is termed Simple. An example of a Simple Partial Seizure is clonic activity of only the right arm. If the seizure spread involves neuronal circuits affecting consciousness, then it is termed Complex. An example of a Complex Partial Seizure is when a person stops speaking, smacks his lips and is unresponsive to verbal commands for several minutes. Afterwards he will feel tired and not remember everything about the preceding seizure. Either type of partial seizure can go on to spread sufficiently so as to result in a generalized “Grand mal” seizure. Since the seizure first started focally, we say it was a Partial Seizure (simple or complex) with secondary generalization. Partial seizures are divided into simple, complex and those seizures that evolve from partial–onset into generalized tonic–clonic seizures. The difference between simple and complex seizures is that during simple partial seizures, you retain awareness. During complex partial seizures, you lose awareness.

Primary Generalized Seizures

When the abnormal electrical discharges are bilaterally synchronous at the onset. Because these seizures are without a focal onset, there can be no “Aura”, which is a warning sign and actually represents a focal or partial seizure. There are six types of generalized seizures.

Tonic–clonic (“Grand–mal” seizure)

You may lose consciousness and often collapse. The body becomes stiff and shakes, and finally, one falls into a deep sleep. Injuries such as tongue–biting can occur, or you can lose bladder control.

Absence seizure (“Petit mal” seizure) You may lose awareness and gaze blankly for a few seconds. Most often there are no other symptoms except the seizures may occur a few times everyday.

Myoclonic seizure Your body may jerk, as if being electrocuted, from a single muscular jerk to the entire body.

Clonic seizure Both sides of your body jerk rhythmically at the same time.

Tonic seizure Muscles suddenly become very stiff.

Atonic or akinetic seizure Muscles relax suddenly, which can cause a sudden fall causing injuries.

Etiology

By and large, the primary generalized epilepsies, such as absence, grand mal (tonic–clonic), and myoclonic are genetically determined and present in childhood and adolescence. The partial epilepsies are more likely to be acquired (congenital, post traumatic, infection, tumor) and present in any age.

Natural history

Although certain stimuli can increase the probability of having a seizure, their occurrence is unpredictable. Many of the patients with primary generalized epilepsy will stop having seizures as they enter adulthood (independent of treatment). Medications (anticonvulsants, antiepileptics, antiseizure are valid terms to precede the word medication or drug) help prevent seizures but do not cure the patient of his epilepsy. The partial epilepsies are the most difficult to treat.

Epileptic seizures can take a very wide variety of forms but are broadly divided into generalized and focal or partial seizures. Partial or focal seizures affect part or a whole limb and may or may not become generalized. If there is no alteration in consciousness it is known as simple partial or Jacksonian seizures and if consciousness is altered or lost it is known as complex partial seizures, commonly known as psychomotor or temporal lobe epilepsy. Generalised seizures affect the whole body and consciousness is lost. However, by far the most common is Generalised seizures (involving the whole brain) commonly known as “Grand Mal” or “Tonic Clonic” seizures or major seizures.

People with epilepsy experience more than one type of seizure. The two categories of seizures are called generalized and partial.

A) Generalized Seizures
Generalized seizures result from electrical impulses arising from the entire brain. They typically occur without warning. There are six types of generalized seizures.
  • Absence seizure – You will lose awareness and stare blankly for a few seconds. Usually, there are no other symptoms. These seizures may occur several times a day.
  • Atonic seizure – During this kind of seizure, your muscles will relax, particularly in the arms and legs, which can cause you to suddenly fall and often injure themselves.
  • Clonic seizure – Both sides of your body jerk rhythmically at the same time.
  • Myoclonic seizure – Your body may jerk, as if being shocked by electricity. The jerks can range from a single muscle jerking to involvement of the entire body.
  • Tonic-clonic – You will lose consciousness and may also collapse. Your body becomes stiff and begins jerking. Finally, your child will fall into a deep sleep. Injuries such as tongue-biting can occur, as well as a loss of bladder control.
  • Tonic seizure – Your child’s muscles suddenly become very stiff.
B) Partial Seizures
Partial seizures originate from activity in a smaller part of the brain. They are divided into simple and complex.The difference between simple and complex seizures is that during simple partial seizures, your child will retain awareness. During complex partial seizures, your child will lose awareness.
  • Simple partial seizure – Your child may experience movements such as jerking or stiffening, various sensations. Full consciousness is retained.
  • Complex partial seizure This is the same as a simple partial seizure except that your child’s awareness is impaired. He or she may appear to be “Out of touch” or “Spaced out.” Your child also may involuntarily chew, walk, fidget or perform other repetitive movements or simple actions.
Although the symptoms listed below are not necessarily indicators of epilepsy, it is wise to consult a doctor if you or a member of your family experiences one or more of these symptoms:
  • “Blackouts” or periods of unclear memory.
  • Episodes of staring or unexplained periods of unresponsiveness.
  • Involuntary movement of arms and legs.
  • “Fainting spells” with involuntary urination or defecation followed by excessive fatigue. or
  • “Hearing of odd sounds”, distorted perceptions, feelings of fear or emotional distress that cannot be explained.
Seizures can be Generalized (‘Grand Mal’) or Partial (‘Petit Mal’ or ‘Absence’) or of a type that affects only a localized area of the brain (‘Partial seizures’). Generalized seizures manifest as episodes of involuntary twitching of the extremities, uncontrolled head movement, frothing at the mouth, rapid eye movement, usually followed by a period of unconsciousness. For a varying period of time after an epileptic seizure, the patient may be confused & unresponsive.
Seizures are partial when the abnormal electrical activity is limited to one part of the brain. Such partial seizures can cause periods of “Repetitive behavior” and altered consciousness. This is characterized by behavior, such as buttoning or unbuttoning a shirt. Such behavior, however, is unconscious, may be repetitive, and is usually not remembered.

People with epilepsy can live normal lives. Many athletes, authors, politicians, entrepreneurs, doctors, parents, and artists have epilepsy. Epilepsy can put a strain on families. So each member of the family needs to understand what epilepsy is, how it’s treated, and what to expect. Families can be a great source of support for someone with epilepsy–but it might take some work. Encourage all members of your family to learn as much as they can.

If you have epilepsy, you can still become involved in extracurricular activities.Your doctor will give you instructions about taking precautions to protect yourself in various situations. For example, teens with epilepsy can enjoy swimming, but should always swim with other people to be safe. Aside from some minor safety precautions, though, you can enjoy all the stuff your friends and classmates do. As long as epilepsy is under medical control, people with epilepsy are able to drive.

Tell the people close to you, your friends, relatives, teachers about your epilepsy and teach them what to do in case you have a seizure when they’re with you.

Since seizures are unpredictability in terms of their nature, timing, severity and the situations in which they can occur, can cause social difficulties. Taking an active role in managing your own epilepsy is an important part of coping successfully.

Driving
Epilepsy does not automatically disqualify you from being legally permitted to drive. In fact, many people with epilepsy do drive. Generally people with epilepsy must not drive unless they have been free from seizures for atleast 6 months and the medication does not cause drowsiness or poor co–ordination. If you have not had a seizure for over two, you may be considering quitting medication. However, if you stop medication and a seizure recurs, you will have to stop driving again for at least a further year. For many this is a very difficult decision.

Work
Companies do not single out people with epilepsy. But there are many jobs which are not possible for example commercial driving, airline pilot, armed forces. At times employers worry about productivity, absenteeism, liability, reaction of customers or co–workers and workplace safety.

School
Most children with epilepsy go to normal schools. Children with epilepsy do not have any other disability, and the seizures are well controlled. You should inform the principal and teachers about the problem, most teachers will understand the correct use of medication and will not hesitate to do their best if the child has an attack.

Sport and leisure
Epilepsy is not a disease that has limitations for active and normal life. Patients can and should participate in most sports, but with informed and qualified supervision and, relevant safety measures where required.

Travel
As long as you have medication with you during your travels it is fine. Try to keep journeys short, break it up and do not tire yourself as that may make more prone to a seizure. Also when flying, ‘Jet–lag’ may make you tired. But this should not stop you from travelling. Ideally you should travel with someone or that someone on the trip is aware of your situation.

Sex and the contraceptive pill
People with epilepsy do come across sexual difficulties. Epilepsy can have effect on sex, and sex has effect on epilepsy. One of the commonest sexual effects of epilepsy is the decrease or loss of desire. This can be due to many reasons, the medication to reactions of partners or epilepsy itself. Some medicines used to treat epilepsy interfere with ‘The pill’, and a higher dose pill may be needed for effective contraception. Your doctor will give you the right advise.

Pregnancy
During pregnancy you must make sure that seizures are minimal. However, epilepsy and the medications to treat it can have many effects on the mother, the pregnancy, and the fetus and newborn. Though most women are able to have a healthy pregnancy and baby, there are risks these include stillbirths, slightly smaller babies and perhaps high blood pressure. Before becoming pregnant it is best to seek advice from a doctor, Anticonvulsant drugs interfere with folic acid therefore you should take extra folic acid before and throughout the pregnancy. This reduces the chance of certain abnormalities occurring. If you have an unplanned pregnancy, do not stop medication but see a doctor as soon as possible.

Tips for living with epilepsy

  • Make sure you get at least 8 hours of sleep everyday. Lack of sleep is known to trigger epilepsy.
  • Take your antiepileptic medicines at a regular time everyday as specified by your doctor.
  • Fasting is OUT! Eat proper, balanced meals and drink at least 6–8 glasses of water per day to maintain hydration.
  • Infections are often associated with worsening of seizures, especially if associated with fever.
  • Do not work on the computer for too long at a stretch. Take adequate breaks.
  • Too much television viewing is dangerous too. Certain patterns and colors are known to trigger epilepsy. In fact just last year, a Japanese
  • Children’s TV program was discontinued when it triggered epilepsy in 9 children.
  • Do not take over the counter medicines for cold as they may contain ephedrine & pseudoephedrine, Known to be triggers.
  • Certain drugs are known to aggravate seizures – It is best to avoid chlorpromazine, quinolone group of antibiotics (ciprofloxacin), stimulants, etc. Your doctor will be able to guide you if you have any doubts about your medicines, food, etc.
Most pregnant women with epilepsy have a normal pregnancy and childbirth. Being pregnant does not usually make epilepsy any better or worse. However, for women with epilepsy, the risk of complications during pregnancy and labor is higher than for women without epilepsy. The small increase in risk is due to the small risk of harm coming to a baby if you have a serious seizure whilst pregnant, and the small risk of harm to an unborn baby from anti–epilepsy medicines (discussed further below).

Therefore, before becoming pregnant, it is best to seek advice from a doctor, epilepsy nurse, or counsellor. The potential risks can be discussed. Some of the points are briefly mentioned below.

Before becoming pregnant
Most of the advice is the same as for any other woman. (This is discussed in a separate leaflet called ‘Planning to Become Pregnant?’. For example, advice on diet, smoking, alcohol, avoiding infection, etc.) The additional issues that relate to women with epilepsy include
  • You may wish to discuss the relative benefits and risks of adjusting medication.
  • If you have not had any seizures for some time, you may wish to consider stopping anti–epilepsy medication before becoming pregnant. Deciding to come off anti–epilepsy medication can be a difficult decision. Factors such as the type of epilepsy that you have can be important. For example, if you have the type of epilepsy that causes severe tonic–clonic seizures, there is a risk that you could have a severe seizure when you are pregnant if you stop your medication.
  • All women taking anti–epilepsy medication are recommended to take 5 mg per day of folic acid before becoming pregnant, and continued until 12 weeks of pregnancy. Folic acid is recommended for all women who are pregnant, but the dose for women taking anti–epilepsy medicines is higher than usual. If you take folic acid tablets in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida.
  • You may wish to discuss the question ‘What are the risks that my child will also have epilepsy?’. In general, the probability is low that a child born to a parent with epilepsy will also have epilepsy. However, it can partly depend on your family history as some types of epilepsy run in families. Therefore, genetic counselling may be an option to consider if one partner has epilepsy, particularly if the partner has idiopathic epilepsy (epilepsy of unknown cause) and a family history of epilepsy.
  • If you do become pregnant, you will be encouraged to notify your pregnancy to the UK Epilepsy and Pregnancy Register (see www.epilepsyandpregnancy.co.uk for details). This is a major ongoing research study that collects information about the safety of anti–epilepsy medicines in pregnancy.
Risk from seizures occurring during pregnancy
The risk of having a seizure is much the same during pregnancy as when you are not pregnant.
  • If you have generalized tonic–clonic seizures, there is a small risk that a severe or prolonged seizure may harm the unborn baby. However, the risk is small, and the baby is not affected during most seizures. The risk of a tonic–clonic seizure during childbirth is low. However, to play safe, childbirth should take place in hospital with facilities for mother and baby resuscitation.
  • If you have partial seizures, absence seizures, or myoclonic seizures, a seizure is not likely to cause harm to a baby (unless you fall and badly injure yourself).
Risk from anti–epilepsy medicines
If you take anti–epilepsy medication when you are pregnant, you have a small increased risk of having a baby with a birth defect. The most common birth defects that occur are neural tube defects (such as spina bifida), facial defects, congenital heart defects, and hypospadias (a defect of the penis).
  • Overall, about 4 in 100 pregnant women who take one anti–epilepsy medicine have a baby with a birth defect. The risk rises to about 6–7 in 100 when taking two anti–epilepsy medicines.
  • However, the risks from different medicines can vary. For example, the risk for sodium valproate is about 7 in 100 whereas the risk for carbamazepine is about 2 in 100 and the risk for lamotrigine is about 3 in 100. Therefore, if possible, sodium valproate is not prescribed to women who may become pregnant.
  • Taking folic acid 5 mg daily (as discussed above) is thought to reduce the risk from anti–epilepsy medicines during pregnancy.
  • Pregnant women who are taking anti–epilepsy medicines are usually offered a high–resolution ultrasound scan to screen for birth defects at 18–20 weeks pregnancy. However, earlier scanning may allow major birth defects to be detected sooner.
  • If you have an unplanned pregnancy, do not stop your anti–epilepsy medication without advice which may put you at risk or having a seizure. However, see a doctor as soon as possible and start taking folic acid 5 mg daily straight away
Breastfeeding
Breastfeeding for most women taking anti–epilepsy medication is generally safe.
Maternal illness during pregnancy
Injury or illness to an expectant mother can affect the developing brain in the fetus during pregnancy. Heredity. Researchers are continually examining the role of heredity and genetics in the development of seizure disorders. Besides the above causes, there are times when people find that certain incidents can trigger a seizure. This does not mean that it is the root cause of epilepsy. It might help to keep a diary and keep track of events, this may help show a pattern which may pinpoint an avoidable cause.
  • Infections illnesses
  • Fever
  • Fatigue
  • Low blood sugar due to poor diet
  • Stress or anxiety
  • Insomnia
  • Alcoholism and drug abuse
  • Uncommon medicines, anti–depressants, anti–psychotic medication
  • Menstruation (periods)
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.

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.
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.
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