Epilepsy

Epilepsy is a relatively common disorder of the neurological system, presenting with random, recurrent seizures caused by excessive, abnormal or synchronous neural activity in the brain

Epilepsy affects around fifty million people globally at any given time, making it a substantial worldwide health concern. Medical treatments usual focus on management and control of the disease and associated symptoms, rather than a complete cure.

Although in very serious cases surgery may be considered as an option. There are various different types of epilepsy, some of which are chronic and some temporary.

For example, there are kinds of epilepsy that only occur during certain stages of childhood. Therefore epilepsy is not one disease as such, but rather a collection of conditions presenting with similar symptoms and sharing common treatment options. All forms of epilepsy concern abnormal brain activity.

Part of the definition of epilepsy is that seizures are unprovoked, meaning that the cause of a seizure cannot be obvious or predicted. Although many epileptics associate the onset of their condition with flashing lights, reading, hyperventilating, or other common everyday situations. Epilepsy brought on by flashing lights is known as photosensitive epilepsy, and is responsible for about 5% of all epileptic seizures.

Other environmental factors which may cause seizures in people predisposed to experience them include - sleep deprivation, stress, anxiety, sleep, menstruation, constipation and alcohol.

Medical professionals will general treat epilepsy with medication. Various tests may be undertaken in order to properly diagnose and treat the disease, and a patient may have to see a neurologist or neurosurgeon at some stage as well as their primary caregiver.

For some epileptics, a change of diet can help to reduce the frequency of their seizures. In others, surgery may be performed in order to implant a device that stimulates the vagus nerve. This treatment has proven effective in many cases. Sometimes surgery may cure a patient completely and they will never have another seizure again in their lives. Other times the procedure will only limit the frequency and/or severity of epileptic fits.

AEDs are antiepileptic, or anticonvulsant drugs, which are taken (usually daily) to reduce the frequency and severity of epileptic attacks. Many of these drugs have side-effects that can affect different patients, so a variety of drugs may need to be tried before an epileptic finds one that works for him or her. Anticonvulsants can sometimes cause patients to enter complete remission, when they will be considered to be essentially cured.

Sometimes a combination of drugs may be tried, along with an increased dosage to try to find the right solution for a particular patient. The typical strategy employed is to try various medications, and increase the dosage until either the epilepsy is controlled, or side-effects of the medication begin to manifest themselves.

Antiepileptic or anticonvulsant serum levels may be used by doctors to ‘fine tune’ levels and combinations of drug treatments and provide a better likelihood of curing the disease. the use and extent of this process varies greatly from clinician to clinician, but most consider it to be effective to some extent, as the effective therapeutic dosage of AEDs can vary greatly from patient to patient.

If an appropriate combination of drugs and levels of drugs cannot be found, a patient’s epilepsy is described as medically refractory.

Some different drugs being used commonly to treat epilepsy in its various forms today include: clobazam (Frisium), clonazepam (Klonopin), felbamate (Felbatol), fosphenytoin (Cerebyx), flurazepam (Dalmane), levetiracetam (Keppra), oxcarbazepine (Trileptal), mephenytoin (Mesantoin), phenobarbital (Luminal), gabapentin (Neurontin), lamotrigine (Lamictal), phenytoin (Dilantin), pregabalin (Lyrica), primidone (Mysoline), sodium valproate (Epilim), tiagabine (Gabitril), valproic acid (Depakene, Convulex), vigabatrin (Sabril), topiramate (Topamax), and valproate semisodium (Depakote, Epival).

Other drugs can be useful in controlling, ending or lessening a seizure that is already in progress. These include lorazepam (Ativan) and diazepam (Valium). Other drugs that are employes solely to treat refractory status epileptics are pentobarbital (Nembutal) and paraldehyde (Paral).

Valproates should not be taken while pregnant, because of the possibility of the child having a reduced IQ.

Epileptic seizures used to be treated using bromides, but this practice is obsolete now due to the limited success and high toxicity (and potential side-effects) of these drugs.

Some kinds of epilepsy may be controlled by means of a ketogenic diet, but this theory is not yet developed. A ketogenic diet is very low in carbohydrates and high in fat, with limited fluid intake. A ketogenic diet should only be tried as therapy for epilepsy after all possible drug treatment options have been exhausted. Studies have shown that up to fifty percent of epileptics may experience a reduction of their symptoms following conversion to such a diet.

VNS is vagus nerve stimulation. This (as mentioned briefly above) involves implanting a device similar to a heart pacemaker into the neck of a patient. The device emits electronic pulses which stimulate the vagus nerve at precise times and in precise amounts. Around 50% of all patients who try this approach will experience a permanent and significant reduction in the frequency and violence of their seizures.

RNS is a responsive neurostimulator currently undergoing clinical trials. Similar to VNS, the RNS is implanted underneath the scalp and deploys electric shocks in the event of a seizure, target at the area of the brain where seizure are thought to originate. The main difference between VNS and RNS is that VNS is preemptive whereas RNS is responsive. RNS is thought to provide better control and monitoring of seizures and may help doctors to better understand a patient’s pattern of epilepsy and therefore provide more tailored treatment options.

Alternative methods for treatment of epilepsy include acupuncture, vitamins, exercise (particularly yoga), and psychotherapy. These solutions have varying degrees of reported success, and should not be undertaken in lieu of proper medical care.