Epilepsy Overview
Epilepsy is a neurological condition that causes recurring seizures. Different types of epilepsy are classified based on where seizures occur in the brain, how severe they are, and what symptoms appear before, during, and after a seizure. Antiepileptic drugs (AEDs) are usually the first line of treatment, and neurologists may prescribe more than one drug to control seizures more effectively.
If medications are not successful, alternative treatment methods are available, though they are typically considered only when absolutely necessary.
Treatment by Type of Epilepsy
Most epilepsy cases are manageable with antiepileptic medications prescribed by a neurologist. Over 25 drugs are approved for epilepsy treatment, and most are taken twice daily, though some exceptions exist. It's important to follow your doctor’s instructions carefully when taking these medications.
When selecting a medication, neurologists consider factors like age, sex, and seizure type to maximize effectiveness and minimize side effects.
Often, treatment is successful enough that people can eventually stop taking medication. More than 70% of children with common epilepsy types can discontinue medication, and over two-thirds of adults achieve seizure-free periods after two years of treatment, allowing them to taper off medication.
Treatment-Resistant Epilepsy
Some people do not respond to medications, a condition known as treatment-resistant epilepsy. If the first two medications are ineffective, other options are considered.
For focal seizures (seizures in one part of the brain), surgery may be used to remove the seizure-causing area or prevent the spread of seizures. For generalized seizures (affecting the whole brain), devices like vagal nerve stimulators can be implanted to help prevent seizures, similar to a pacemaker for the brain.
Treatment for Focal Onset Epilepsy
Focal onset seizures can affect sensations, movements, and consciousness. Treatments include medications, surgery, and potential dietary interventions like the ketogenic diet.
Drug Treatments
Common medications for focal epilepsy include:
- Lamictal (lamotrigine)
- Keppra (levetiracetam)
- Trileptal (oxcarbazepine)
- Tegretol/Curatil (carbamazepine)
- Vimpat (lacosamide)
Special recommendations:
- For older adults: Lamictal, Keppra, Vimpat
- For people who are pregnant or trying to conceive: Lamictal, Keppra
Surgery
When medications fail, surgical options include:
- Lobectomy or lesionectomy: Removing the part of the brain causing seizures
- Multiple subpial transection (MST): Cutting nerve fibers to prevent seizure spread
- Corpus callosotomy: Severing the corpus callosum to stop seizure transmission
- Thermal ablation: Using lasers to destroy seizure-causing areas (minimally invasive)
- Hemispherectomy: Removing one-half of the brain (used rarely, mainly in children)
Ketogenic Diet
The ketogenic diet is high in fat and low in carbohydrates and may help manage treatment-resistant epilepsy. However, more research is needed to confirm its effectiveness.
Side Effects
Antiepileptic drugs may cause drowsiness, dizziness, and balance problems. In rare cases, they can impair cognition or cause hypersensitivity reactions and weight changes. Some medications like valproate can cause birth defects if taken during pregnancy.
Surgical risks include potential damage to healthy brain areas, leading to cognitive or physical impairments or personality changes.
Treatment for Generalized Epilepsy
Generalized epilepsy affects both sides of the brain and can cause tonic-clonic, myoclonic, or absence seizures. Treatments include medications, brain stimulation, and possibly a ketogenic diet.
Drug Treatments
Recommendations vary by seizure type:
- Tonic-clonic seizures: Lamictal, Keppra, Depakene/Depakote (valproate), Topamax, Zonegram
- Myoclonic seizures: Keppra, Depakene/Depakote, Zonegram
- Absence seizures: Zarontin (ethosuximide), Depakene/Depakote, Lamictal
Brain Stimulation
Since seizures are widespread in generalized epilepsy, surgery to remove a brain region is not an option. Instead, brain stimulation devices are used:
- Deep brain stimulation: Continuous stimulation of the anterior nucleus of the thalamus
- Responsive neurostimulation: Stimulation delivered only when seizure activity is detected
Ketogenic Diet
The ketogenic diet is also being studied as a complementary treatment for generalized epilepsy.
Side Effects
Side effects of antiepileptic medications include drowsiness, dizziness, balance issues, cognitive problems, hypersensitivity reactions, and weight changes.
Brain stimulation can cause complications like:
- Burning or prickling sensations
- Pain at the implant site
- Bleeding or infection
- Headache
- Speech disorders
- Potential psychiatric side effects like depression are still under investigation
Living With and Managing Epilepsy
About one-third of people with epilepsy experience cognitive issues, anxiety, or depression. Children may face bullying or loneliness due to seizure stigma. Therapy and counseling can help address these concerns.
People planning to become pregnant should manage their symptoms carefully, as seizures can pose risks to both the pregnant person and the fetus.
Laws in many states require people with epilepsy to be seizure-free for a set period before driving. Many individuals achieve long-term remission, going months or even years without seizures. Wearing a medical alert bracelet is recommended in case of emergencies.
A Quick Review
Epilepsy is a neurological disorder involving recurrent seizures. Fortunately, many treatments are available, including medications, surgery, and brain stimulation devices. Many people experience long-term remission after successful treatment, allowing them to live fuller lives.
