Treating Epilepsy
Drug Therapy
Many seizure disorders are controlled by various types of anti-seizure medications (sometimes called anti-convulsants or anti-epileptic drugs [AEDs]). Monotherapy (using 1 drug), or polytherapy (using a combination of drugs) may be prescribed by your doctor. Different types of seizures require different medications. Many drugs may produce numerous and unwanted side effects.
Resistance to Medication
Approximately
- 50% of seizures are eliminated by medication,
- 30% of seizures are reduced in intensity and frequency by medication,
- 20% of seizures are resistant to medication.
History of Medications
For more than 100 years, various kinds of medications have been used to treat seizure disorders.
- 1861 — Bromides
The first medication used to provide control of seizures. Side effects were severe. - 1912 — Phenobarbital
Somewhat effective, but many side effects. - 1936 — Phenytoin was known as the "miracle drug" of its day.
- Today — New medications more specific to GABA (a major inhibitory neurotransmitter involved in motor control) are available.
- The Future — Research continues to be done in an effort to find a safe, effective anti-convulsant.
Vagus Nerve StimulationVagus Nerve Stimulation (VNS) involves periodic mild electrical stimulation of the vagus nerve in the neck by a surgically implanted device similar to a heart pacemaker.
VNS has been found effective in controlling some epilepsies when anti-epileptic drugs have been inadequate or their side effects intolerable, and neurosurgery has not been an option.
Common side effects, which occur only during stimulation, may include a tingling sensation in the neck and/or mild hoarseness of the voice. Other possible side-effects may include coughing, voice alteration, shortness of breath, transient sensations of choking, throat pain, ear or tooth pain, and skin irritation or infection at the implant site. Unlike many medications, there seems to be no significant intellectual, cognitive, behavioural or emotional side effects to VNS therapy.
VNS is approved in more than 20 countries, and is now the second most common treatment for epilepsy in the USA.
Ketogenic Diet
This strictly supervised diet is prescribed for children. The diet is high in fat and low in carbohydrates. It is prescribed when seizures are drug resistant and surgery is not an option. Seizures are brought under control in many of the children who try the diet, and are eliminated — sometimes permanently — in some of the children who rigidly stick to the diet.
Surgery
Surgery is used when drugs have failed and when the injured brain tissue causing the seizures can be identified and safely removed without damaging psychological or major body functions. This applies only to a small percentage of persons living with epilepsy.
Different types of operations may be performed. In general, they fall into 2 main groups:
- removal of the area of the brain that is producing the seizures;
- interruption of the nerve pathways along which seizure impulses spread.
