Treatment – Epilepsy 101
About 60% of epileptic seizures can be controlled partially or totally by medication. Once control has been established, many persons with epilepsy are virtually seizure-free for a lifetime, allowing them to hold most kinds of jobs and participate in most other kinds of activities. New medications are available which often make it possible to maintain or even improve seizure control with fewer side effects, thereby improving the quality of life. Ask your doctor which of the new drugs are best for you.
The drugs used to control epileptic seizures are called antiepileptic drugs or AEDs. They act in two basic ways:
- By suppressing the undesirable activity of the damaged neurons, thus minimizing the electrical discharge.
- By reducing the responsiveness of neighboring normal neurons, thereby blocking the spread of the excess electrical discharge to other parts of the brain.
The aim of the person with epilepsy is to find the particular drug or combination of drugs that will maximize seizure control while minimizing side effects. This often requires a period of cooperative experimentation and observation during which drugs are tried and dosages adjusted until the desired results are attained.
A percentage of persons with epilepsy have seizures that are not adequately controlled by medications. For many of these persons other treatment modalities are now available. Resective surgery is the preferred option for persons with partial seizures arising from a single focus that is in an operable location. Resective surgery involves identifying the portion of the brain where the seizures originates and removing it.
For persons who are not good candidates for resective surgery, the vagus nerve stimulator (VNS) is another option. This consists of implanting a pacemaker type device in the chest attached to a wire that wraps around the vagus nerve and stimulates it with an electric discharge. VNS has been effective in reducing seizure frequency and severity (though rarely completely eliminating them) in many persons. There are other types of stimulators that are currently being developed.
The ketogenic diet, a diet low in carbohydrates and high in fat is sometimes used, most commonly in children. This is a very restrictive diet that is usually initiated on an inpatient basis and requires careful supervision. There are some modified diets that are also being used with some success.
Persons who are candidates for any of these procedures undergo careful testing to determine if they are appropriate for these interventions. These procedures are generally available only at medical centers that specialize in the treatment of epilepsy.