Epilepsy

Overview

Taking control of seizures

An estimated 2.5 million Americans experience the fear and lack of control associated with epilepsy, a chronic disorder of recurring seizures. Epilepsy is a neurological (brain) condition arising from sudden and unpredictable abnormal electrical discharges in the brain that produces specific changes in behavior and bodily functions. These behavioral changes may range from a momentary loss of awareness to full body convulsions. Many of the causes of epilepsy have been identified, however there are many individuals who have epilepsy for whom no cause can be identified. While most causes of epilepsy are due to injury or chemical disorders, there are some seizure disorders like juvenile myoclonic epilepsy that is inherited. No cure currently exists for epilepsy, but many people maintain a significant degree of control over their seizures through the use of antiepileptic drugs (AEDs).

Detailed Description

Epilepsy is a disorder characterized by recurring seizures (periodic episodes of repetitive, abnormal electrochemical disturbance in the central nervous system, beginning in the brain). Epileptic seizures take a variety of forms that can last from a few seconds to several minutes.

Seizures have three phases: the aura (symptoms that signal an approaching attack), the attack itself, and the recovery (postictal) period during which a headache, fatigue, and other symptoms can last for minutes, or less commonly, longer. Although no treatment plan exists to fully cure the disease, a combination of medical attention and drug therapy has shown promise in curbing the occurrence of seizures. However, there are side effects associated with these treatments. As many as 66% of people with epilepsy benefit from drug therapy, and only half of those who respond to anticonvulsive medications can eventually discontinue treatment with no relapses of seizures.

The number of seizures a person experiences varies substantially among individuals. While most people have one specific type of seizure, others experience a combination of types in various combinations. Seizures are classified as generalized (involving both sides of the brain with at least a momentary loss of consciousness) or focal (starting on one side of the brain or with a single symptom).

How Common Is Epilepsy?

Epilepsy currently affects about 2.5 million U.S. residents or 1% of the total population, with an estimated 125,000 new cases reported each year. The occurrence of a seizure, however, does not necessarily imply epilepsy. At least 8% of the general population will experience at least one seizure during their lifetime. Most will not have recurring seizures, or epilepsy. Children who have experienced an unprovoked first seizure, or idiopathic seizure, and who have a normal electroencephalogram (EEG) have a particularly favorable prognosis. While seizures may strike at any age, 75% of first seizures occur during childhood and adolescence with no identifiable cause. There is no data to suggest that epilepsy preferentially affects one gender over another.

Conventional Treatment

Goals of Treatment

Although there is no known cure for primary epilepsy, it can usually be managed with medication. Most people with epilepsy can achieve complete control of their seizures while others can have partial control. For the small number of people for whom medication can't control their seizures, surgical procedures may be an alternative and are very effective.

Treatment Considerations

Complete prevention of seizures is one of the primary goals of treatment. If this is not possible, a marked reduction in their frequency is the next goal. Because each person with epilepsy has a unique set of seizure patterns, therapy must be tailored to the individual. The drugs used to control epilepsy are selected according to the specific patterns and type of seizures the person experiences, and the issues of side effects and drug tolerance are determined on an individual case-by-case basis. The ideal treatment would be complete control of seizures with one drug, but this is possible in only 85% of the cases. Psychological factors that may decrease the frequency of seizures in susceptible people can be addressed through support groups, education, and self-awareness.

Drug Therapy

While antiepileptic drugs (AEDs) do not constitute a comprehensive cure for epilepsy, they have been proven effective in reducing the frequency and severity of seizures. Uncontrolled convulsions can provoke additional injury and brain damage. Side effects associated with the use of AEDs include, but are not limited to, impaired cognitive ability, hyperactivity, skin rashes, weight gain, nausea, insomnia, headaches, and digestive discomfort. Side effects of properly prescribed AEDs are usually tolerable. Abrupt AED withdrawal can trigger a severe condition of prolonged continual seizures without interruption, known as status epilepticus.

It is important that antiepileptic drug therapy be adhered to rigidly as prescribed by the doctor. Any deviation from the schedule can hasten a spontaneous recurrence of seizure activity. Periodically blood tests are necessary in order to determine if the prescribed drugs are being properly absorbed and eliminated. These tests help determine the optimal dosage for each drug, and thereby establishing a drug level that will ensure freedom from seizures without toxic drug effects.

Drugs most commonly prescribed
Depending on the type of seizure you have drugs prescribed may include:
Depakene
Depakote
Diamox
buy Neurontin
Tegretol
Dilantin
Mysoline
Lamictal

Surgery

A craniotomy is sometimes recommended if medication is ineffective in controlling seizures. This type of surgery removes a structure or lesion that causes seizures. These surgeries are performed at the specialized epilepsy treatment facilities of large medical centers. Anticonvulsant drugs may still be prescribed after the surgery.

Activity & Diet Recommendations

Restricting daily activities is not recommended for most epileptic people, as it can lead to isolation and feelings of exclusion. You may need to restrict a few activities, however, for your own safety and the safety of others:

• Driving with the threat of seizures can be dangerous, but once the seizures are under control, driving is possible. Most states allow people with epilepsy to drive once they have been seizure-free for one year.
• Avoid swimming alone.
• Avoid working at heights (for example, don't climb a ladder to paint your house).
• Avoid operating heavy or dangerous machinery.
• Wear a helmet when biking, skating, or doing other rigorous physical activity.

There are several nutritional elements that can be helpful in the treatment of epilepsy. You should attempt to eat regular meals to keep blood sugar levels constant for energy and consistent brain neuron transmission.

• Ketogenic diet: In some children, seizures have been controlled when the child fasted or avoided eating. Obviously this is an impossible long-term treatment. However, neurologists at Johns Hopkins University devised a diet that mimics the metabolism of a person who is fasting. This diet includes a high intake of fats, only enough protein for growth, and few-to-no carbohydrates. Recommended for some children, this diet provides an alternative for those who have severe side effects from anticonvulsant drugs or whose seizures cannot be controlled by medication. It's also important that the diet be tailored individually to each person. After two years on the diet, most people experience control of their seizures and can return to a normal diet without a recurrence of seizures.
• Alcohol Avoidance: Alcohol can decrease the effectiveness of your medication and could provoke seizures.

Quality of Life

People who experience the fear and loss of control associated with seizures can have difficulty in social, work, and intimate settings. Because of this, epilepsy can have a catastrophic impact on important aspects of the quality of life. A lack of understanding by others can leave the person with epilepsy feeling isolated and excluded from human contact, career opportunities, and educational possibilities. Supportive friends and family, education, and psychotherapeutic counseling may all help increase the quality of life for a person with epilepsy. Controlling seizures as much as possible can increase confidence and help the person function as normally as possible.

Considerations

Pregnancy
The issue of pregnancy is complicated for women with epilepsy. While over 90% of women taking antiepileptic drugs during pregnancy give birth to normal infants, it is important to note that birth defects are two to three times higher in children whose mothers took phenytoin, trimethadione, or valproic acid during pregnancy. You should talk to your doctor before you get pregnant, as the question of drug use during pregnancy poses some serious questions. The risk of seizures could be more harmful to the fetus than the risk of drug-induced birth defects; the risk of seizures to the mother also needs to be considered.

Nursing mothers
Many antiepileptic drugs are secreted to the baby during breastfeeding, which should be discussed with a doctor. If a mother taking anticonvulsive medication is breastfeeding, the drug concentration in the infant may require monitoring if problems, such as sedation, occur.

Considerations for Children and Adolescents

Every attempt should be made to provide your child with normal opportunities for growth, learning, and development. Insuring the child's safety by making sure he or she doesn't swim alone, wears a helmet when biking or skateboarding, and doesn't get in situations that would be dangerous if a seizure occurs, are all important elements in helping the child cope with epilepsy. Make sure that your child always wears a Medic-Alert bracelet or pendant that mentions epilepsy, in case your child has a seizure.

Inform your adolescent of the danger of drinking alcohol. Explain how it decreases the effectiveness of medication and may provoke a seizure.

Considerations for Older People

Strokes, tumors, and degenerative disease are likely causes of 90% of new-onset seizures found in older people. If antiepileptic drugs are necessary, you will likely begin with small doses and increase your dosage gradually to control tolerance.

Self care & Prevention

Preventing Epilepsy

The majority of epilepsy cases are incurable. The principal methods of prevention are genetic counseling and family planning. Avoidance of head injury and containment of risk factors can reduce the risk of contracting secondary epilepsy.

Self-Care Measures

Avoiding environmental and lifestyle triggers can help decrease the occurrence of seizures. Alcohol and drugs should be eliminated as they can effect medication and cause seizures. Vigorously treat infections anywhere in your body. Eat a consistent, healthy diet with regularly scheduled meals. In addition, the following tactics may help:

• If you've ever had a seizure, wear a Medic-Alert bracelet or necklace so that first-aid providers will know that you have seizure disorder.
• Just about anything can trigger seizures, notably stress, but also fatigue, alcohol or drug consumption, flashing lights, even certain television programs. Record your triggers and work to avoid them.
• Manage your stress. Get regular exercise — it helps control stress.
• Eat regular meals and snacks. Several studies show that low blood sugar (hypoglycemia) is a risk factor for seizures. Keep your blood sugar up by not skipping meals. In addition, snack between meals.
• As a last resort, try increasing the fat in your diet. Use this approach carefully, though, as a high-fat diet can contribute to heart disease, many cancers, stroke, obesity, diabetes, arthritis, and many other ills. However, it also helps to prevent seizures. If your seizures cannot be controlled in other ways, consult your doctor and a clinical nutritionist about a monitored program for increasing the fat in your diet.

Psychological issues such as fear and exclusion that arise from experiencing seizures in public can be addressed by educating those in your life about epilepsy. Personal counseling, support groups, and an understanding group of friends and family can all help in dealing with the emotional impact of the unpredictable nature of epileptic seizures.