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What to do When Epilepsy Medication Fails
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Portrait of a Child with Epilepsy
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Taking Control of Seizures: A Personal Look
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Treatment Options for Children with Epilepsy
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Seizures While You Sleep?
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Seizure Control: What Can You Take for Epilepsy?
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Treatments
Treatment is targeted primarily to:
- assist the patient in adjusting psychologically to the diagnosis and in maintaining as normal a lifestyle as possible
- reduce or eliminate seizure occurrence
- avoid side effects of long-term drug treatment
Simple and complex partial seizures respond to drugs such as carbamazepine, valproic acid(valproate), phenytoin, gabapentin, tiagabine, lamotrigine, and topiramate. Tonic-clonic seizures tend to respond to valproate, carbamazepine, phenytoin, and lamotrigine. Absence seizures seem to be sensitive to ethosuximide, valproate, and lamotrigine. Myoclonic seizures can be
People treated with a class of medications called barbiturates(Mysoline, Mebral, phenobarbital) have adverse cognitive (thinking) effects. These cognitive effects can include decreased general intelligence, attention, memory, problem solving, motor speed, and visual motor functions. The drug phenytoin (Dilantin) can adversely affect speed of response, memory, and attention. Other medications used for treatment of seizures do not have substantial cognitive impairment.
Surgical treatment may be considered when medications fail. Advances in medical sciences and techniques have improved methods of identifying the parts of the brain that generate abnormal discharge of nerve impulses. Surgical treatment now accounts for about 5,000 procedures annually. The most common type of surgery is the focal cortical resection. In this procedure, a small part of the brain responsible for causing the seizures is removed. Surgical interventionmay be considered a feasible treatment option if:
- the site of seizures is identifiable and localized
- surgery can remove the seizure-generating (epileptogenic) area
- surgical procedure will not cause damage to nearby areas
Prognosis
About 30% of patients with severe seizures (starting in early childhood), continue to have attacks and usually never achieve a remission state. In the United States, the prevalence of treatment-resistant seizures is about one to two per 1,000 persons. About 60–70% of persons achieve a five-year remission within 10 years of initial diagnosis. Approximately half of these patients become seizure-free. Usually the prognosis is better if seizures can be controlled by one medication, the frequency of seizures decreases, and there is a normal EEG and neurological examination prior to medication cessation.
People affected by seizure have increased death rates compared with the general population. Patients who have seizures of unknown cause have an increased chance of dying due to accidents (primarily drowning). Other causes of seizure-associated death include abnormal heart rhythms, water in the lungs, or heart attack.
Prevention
There are no gold standard recommendations for prevention, since seizures can be caused by genetic factors, blood abnormalities, many medications, illicit drugs, infection, neurologic conditions, and other systemic diseases. If a person has had a previous attack or has a genetic propensity, care is advised when receiving medical treatment or if diagnosed with an illness correlated with possible seizure development.
See also Computed tomography (CAT); Electroencephalography (EEG); Magnetic resonance imaging (MRI); Substance abuse and related disorders
BOOKS
Goldman, Lee, and others. Cecil Textbook of Medicine.21st edition. Philadelphia: W. B. Saunders Company, 2000.
Goroll, Allan H. Primary Care Medicine.4th edition. Philadelphia: Lippincott Williams and Wilkins, 2000.
Goetz, Christopher G . Textbook of Clinical Neurology.1st edition. Philadelphia: W. B. Saunders Company, 1999.
PERIODICALS
Dodrill, C. R., C. G. Matthew. "The role of Neuropsychology in the Assessment and Treatment of Persons with Epilepsy." American PsychologistSeptember 1992.
ORGANIZATIONS
Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223. Phone: (800) 332-1000. Web site: <http://www.efa.org/>.
Laith Farid Gulli, M.D.
Alfredo Mori, M.D., FACEM
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Author Info: Laith Farid Gulli M.D., Alfredo Mori M.D., FACEM, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Mental Disorders, 2003 |
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