How is epilepsy treated?
A. People with epilepsy can obtain treatment and information from a wide range of sources including family physicians, neurologists, neurology nurses, epileptologists and pediatricians. A variety of treatments are available, however, most physicians prefer long-term anti-epilepsy drug therapy over any other treatment. An estimated 30 percent of patients still experience seizures despite treatment. For these people, specialized care is available at medical centers, neurological clinics and other hospitals. Neurological specialists who work for private practices also offer specialized care.
Before treatment begins, physicians usually obtain an electroencephalogram (EEG). EEGs help to diagnose epilepsy, identify the type of epilepsy and identify the location in the brain where seizures start. EEGs show electrical activity in the brain and can show abnormal brain-cell function associated with epilepsy when the patient is not having seizures. It should be stressed that up to 50 percent of individuals with seizures might have normal EEGs between recurrences. Some patients will need an imaging study of the brain such as a magnetic resonance imaging (MRI) scan. Once a diagnosis is confirmed, an antiepileptic drug (AED) may be prescribed. Sometimes more than one drug is needed, but in many cases these medications are successful in controlling seizures. A neurologist can assist primary care physicians in determining the right medication or combination of drugs.
My patients often ask, “How many seizures is too many? Should I change my medications?” The answers to these questions are different for each patient. Optimal seizure control allows you to lead a normal, active life. If you think that you are having too many seizures, discuss this with your doctor. Uncontrolled seizures can result in limits on driving, loss of employment, deterioration in school performance, and loss of self-esteem. If your seizures are not under control within a year after diagnosis, request referral to a specialist in brain disorders or epilepsy. The most common treatment for epilepsy is the daily use of anticonvulsant, or antiepileptic, drugs to prevent seizures. These medications act on brain signaling to limit hyperexcitability. While medications do not cure epilepsy, they allow many people to live normal active lives free or nearly free of seizures. Not all patients with seizures require treatment with antiepileptic drugs, and some patients need only one or two y
Epilepsy may be treated with drugs, surgery, a special diet, or an implanted device programmed to stimulate the vagus nerve (VNS therapy). Of these treatments, drug therapy is by far the most common, and is usually the first to be tried. A number of medications are currently used in the treatment of epilepsy. These medications control different types of seizures. People who have more than one type of seizure may have to take more than one kind of drug, although doctors try to control seizures with one drug if possible. A seizure-preventing drug (also known as an antiepileptic or anticonvulsant drug) won’t work properly until it reaches a certain level in the body, and that level has to be maintained. It is important to follow the doctor’s instructions very carefully as to when and how much medication should be taken. The goal is to keep the blood level high enough to prevent seizures, but not so high that it causes excessive sleepiness or other unpleasant side effects.
