The way to deal with recurrent seizures, is a lot more complex. Since 1 in 20 people will have a convulsion at some stage in their lives, doctors generally lake the view not to investigate and treat until a second episode occurs.
When this happens a full investigation is carried out, and if necessary anticonvulsant drugs are used to prevent further attacks. Patients are given advice about how to avoid any trigger factors that may cause their seizures such as stress, too much alcohol, sleep deprivation, fevers and flashing lights (photosensitivity).
After that, the most effective anticonvulsant drugs that control the symptoms but also keep the side effects to a minimum are selected and the patient remains on them until they have been seizure-free for at least 2 years. The aim is to introduce the medication cautiously and to increase the dose in gradual steps. The final dose will be determined by the balance between control of seizures and side effects.
Any possible interactions with other drugs such as aspirin, antidepressants and antacids need to be explained to the patient. It is also important that the recipient of the medication keeps a careful record of their seizures in a diary which will help the doctor adjust the correct dosage of the drug against the symptoms. Sometimes blood tests are taken to see if the blood level of the drug is therapeutically correct.
Another form of treatment for epilepsy is surgery and important steps have been made in the last few years using ‘stereo-tactic’ surgical techniques for the treatment of epilepsy. So much so that it has been estimated that up to 12,500 people in the UK could benefit from this method of treatment. In this procedure, MRI scanning enables the precise location of the source of the seizures to be identified so that that tiny part of the brain can be surgically removed or destroyed.
This is, however, not without risk and tends to be restricted for use with drug-resistant, ‘refractory’ or ‘pharmaco-resistant’ patients, as they are called. Before contemplating such an invasive method of treatment there are three main criteria that have to be fulfilled:
A. The seizures themselves have to be one of the main causes of the patient’s disability.
B. Both the doctor and the patient need to feel that stopping the seizures would result in significant improvement to the patent’s quality of life.
C. The patient must be able to understand the possible risks and benefits of the epilepsy surgery.
The results of the surgery depend on the part of the brain involved and the type of the operation but about 70 per cent of people with an identifiable defect in the temporal lobe of the brain will become seizure-free and another 20 per cent will experience some improvement.
It must be borne in mind, however, that 1 in 10 will appreciate no improvement, or may even be made worse. With modern advanced imaging and surgical techniques the outcome of this kind of surgery continues to improve.
Established drugs used commonly in the treatment of epilepsy include:carbamazepine, clonazepam, ethosuximide, phenobarbitone, phenytoin, primidone and sodium valproate. Newer drugs include gabapentin, lamotrigine, topiramate, vigabatrin and at the current time a dozen new compounds are being developed which look very promising. However, there are no cure-all anticonvulsants that are free of side effects and the search to find an epileptic panacea continues. It is good to recognise that although newer drugs may have fewer side effects than some of the more established ones, the long term side effects are not yet fully known as they have not yet been exposed in clinical use to a large population. Good nutrition should be borne in mind also.