Medical and Surgical Treatment

Medical and Surgical Treatment

Antiepileptic drugs (AEDs) are the mainstay in treatment of epilepsy. There are many AEDs available. When diagnosis of epilepsy is made, treatment should be started immediately. Diagnosing seizure type is important in choosing the best AED to treat epilepsy. There are many factors considered in choosing the most optimal drug. These factors include type of epilepsy syndrome, age, gender, ongoing other medical conditions, other medications taken, potential of becoming pregnant, side effect profile of each drug, and cost of medication. For example valproate has been shown to increase teratogenicity in fetus the most compared to other AEDs, for this reason it should NOT be the drug of choice in young females. Elderly patients should be on AEDs with the least side effect profile and with least drug- drug interaction potential.

The aim of treatment is to get the best seizure control with the possible least number of AEDs, with few or no side effects. In about 70 percent of patients this goal is achieved. In about remaining 30 percent the seizures can be hard to control. In these cases more than one AED will be needed to control seizures. About 30 percent of patients with epilepsy may remain refractory to medical treatment.

In refractory cases the other therapeutic options such as surgery and devices can be considered. The purpose of epilepsy surgery is to resect the focus of seizures. In majority of cases finding of focus is difficult. Also in some cases there may be more than one focus. Other types of surgery are callosotomy, subpial resection, and device placements.

Basic Ways to Control Your Seizures Better

Epilepsy treatment is comprehensive. The medications are the initial step to control seizures. If one medication fails, then another medication is tried. Sometimes two or more medications need to be used. If the medications fail, then other options should be considered. These include surgery, devices, and ketogenic diet.

Treatment of epilepsy requires collaboration between the patient and the doctor. To know your disease better is the first step to improve the control. You need to ask your doctor questions and ask guidance to obtain more information about your epilepsy. You need to learn and understand your medical condition, diagnostic, and therapeutic options.

You need to give your doctor the necessary and correct information about your condition. You should complete seizure calendar which enable you provide accurate information about the seizure frequency.

You need to communicate with your doctor and treatment team effectively and in time. Make sure you have enough refills and prescription before you leave the doctor’s office. Don’t wait until the last day so you can avoid running out of your medication. You should be proactive with your medications.

Try your best not to miss doctor appointments. If you miss an appointment that may mean you may not have enough supply of your antiepileptic medication until your next visit. You may also miss important blood tests which may be important and necessary for ideal treatment and adjustment of dose of your medication(s).

The basic ways to control your seizures better are as follows:

  1. Take your medication in time and regularly. Have a pill box which will help you monitor whether you missed any dose or not. To remind yourself about taking medication, there are gadgets, that may help you such as setting a watch alarm, linking this activity to daily life such taking medications after brushing your teeth in the morning, before getting ready for bed, etc.
  2. Stay away from alcohol and recreational drugs which can provoke seizures.
  3. Avoid sleep deprivation.
  4. Do not miss your regular appointments with your doctor.

What are risks of seizures?

You may harm yourself during a seizure due to falls and injuries. Also you may harm others if you have seizures while driving or using other machinery.

There is also increased risk of sudden unexplained death among patients with epilepsy. Seizures can also cause irregular heart rhythms and heart attacks.

Patients with epilepsy should not use bathtubs. They should not swim without supervision. They should avoid using heavy machines, contact sports, being near open water, or being at heights.

Ketogenic Diet

Treatment of seizures with diet has been tried for many years. The only diet proven to help control seizures is ketogenic diet. It has been more successful in helping children with epilepsy. Versions of ketogenic diet have also been tried in adults with epilepsy.

Ketogenic diet is low in carbohydrate and protein but high in fat. Fat portion occupies about up to five times more than combination of carbohydrate and protein. Due to calory restriction, high fat does not cause weight gain.  High fat causes ketone bodies production to accumulate in blood. Ketone bodies in blood are considered to have anti-seizure effect.

Ketogenic diet should be started under doctor’s supervision due to its complexity.  It requires few days of hospital admission to start this diet.  Dietitian assistance will be needed to stay on this diet. The diet has to be followed exactly.

The effect of diet starts to be seen in a month after being diet. At times, the child can be seizure free.  The effect of diet disappears after it is discontinued. This diet may not work in every child.

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