Epilepsy Health Article

Medication

A combination of drugs may be needed to control some symptoms, but most patients who have epilepsy take one of the following medications:

• Dilantin (phenytoin)
• Tegretol (carbamazepine)
• Barbita (phenobarbital)
• Mysoline (primidone)
• Depakene (valproic acid, sodium valproate)
• Klonopin (clonazepam)
• Zarontin (ethosuximide)

Dilantin, Tegretol, Barbita, and Mysoline are used to manage or control generalized tonic-clonic and complex partial seizures. Depakene, Klonopin, and Zarontin are prescribed for patients who have absence seizures.

Neurontin (gabapentin), Lamictal (lamotrigine), and topiramate (Topamax) are among medications more recently approved in the United States to treat adults who have partial seizures or partial and grand mal seizures. Another new medication called Levetiracetam (Keppra) has been approved and shows particularly good results in reducing partial seizures among elderly patients with few side effects. This is important, because elderly patients often have other conditions and must take other medications that might interact with seizure medications. In 2003, Keppra's manufacturer was working on a new antiepilectic drug from the same chemical family as Keppra that should be more potent and effective. Available medications frequently change, and the physician will determine the best treatment for an individual patient. A 2003 report found that monotherapy, or using just one medication rather than a combination, works better for most patients. The less complicated the treatment, the more likely the patient will comply and better manager the seizure disorder.

Even an epileptic patient whose seizures are well controlled should have regular blood tests to measure levels of antiseizure medication in his or her system and to check to see if the medication is causing any changes in his or her blood or liver. A doctor should be notified if any signs of drug toxicity appear, including uncontrolled eye movements; sluggishness, dizziness, or hyperactivity; inability to see clearly or speak distinctly; nausea or vomiting; or sleep problems.

Status epilepticus requires emergency treatment, usually with Valium (Ativan), Dilantin, or Barbita. An intravenous dextrose (sugar) solution is given to a patient whose condition is due to low blood sugar, and a vitamin B₁ preparation is administered intravenously when status epilepticus results from chronic alcohol withdrawal. Because dextrose and thiamine are essentially harmless and because delay in treatment can be disastrous, these medications are given routinely, as it is usually difficult to obtain an adequate history from a patient suffering from status epilepticus.

Intractable seizures are seizures that cannot be controlled with medication or without sedation or other unacceptable side effects. Surgery may be used to eliminate or control intractable seizures.

Surgery

Surgery can be used to treat patients whose intractable seizures stem from small focal lesions that can be removed without endangering the patient, changing the patient's personality, dulling the patient's senses, or reducing the patient's ability to function.

A physical examination is conducted to verify that a patient's seizures are caused by epilepsy, and surgery is not used to treat patients with severe psychiatric disturbances or medical problems that raise risk factors to unacceptable levels.

Surgery is never recommended unless:

• The best available antiseizure medications have failed to control the patient's symptoms satisfactorily.
• The origin of the patient's seizures has been precisely located.
• There is good reason to believe that surgery will significantly improve the patient's health and quality of life.

Every patient considering epilepsy surgery is carefully evaluated by one or more neurologists, neurosurgeons, neuropsychologists, and/or social workers. A psychiatrist, chaplain, or other spiritual advisor may help the patient and his family cope with the stresses that occur during and after the selection process.

TYPES OF SURGERY. Surgical techniques used to treat intractable epilepsy include:

• Lesionectomy. Removing the lesion (diseased brain tissue) and some surrounding brain tissue is very effective in controlling seizures. Lesionectomy is generally more successful than surgery performed on patients whose seizures are not caused by clearly defined lesions, but removing only part of the lesion lessens the effectiveness of the procedure.
• Temporal resections. Removing part of the temporal lobe and the part of the brain associated with feelings, memory, and emotions (the hippocampus) provides good or excellent seizure control in 75–80% of properly selected patients with appropriate types of temporal lobe epilepsy. Some patients experience post-operative speech and memory problems.
• Extra-temporal resection. This procedure involves removing some or all of the frontal lobe, the part of the brain directly behind the forehead. The frontal lobe helps regulate movement, planning, judgment, and personality. Special care must be taken to prevent post-operative problems with movement and speech. Extra-temporal resection is most successful in patients whose seizures are not widespread.
• Hemispherectomy. This method of removing brain tissue is restricted to patients with severe epilepsy and abnormal discharges that often extend from one side of the brain to the other. Hemispherectomies are most often performed on infants or young children who have had an extensive brain disease or disorder since birth or from a very young age.
• Corpus callosotomy. This procedure, an alternative to hemispherectomy in patients with congenital hemiplegia, removes some or all of the white matter that separates the two halves of the brain. Corpus callosotomy is performed almost exclusively on children who are frequently injured during falls caused by seizures. If removing two–thirds of the corpus callosum does not produce lasting improvement in the patient's condition, the remaining one-third will be removed during another operation.
• Multiple subpial transection. This procedure is used to control the spread of seizures that originate in or affect the "eloquent" cortex, the area of the brain responsible for complex thought and reasoning.