How to treat epilepsy
What is epilepsy? Epilepsy is a chronic (long-lasting) medical condition marked by recurrent epileptic seizures. An epileptic seizure is an event of altered brain function caused by abnormal or excessive electrical discharges from brain cells. Epilepsy is one of the most common neurologic disorders, affecting up to 1 percent of the population in the United States.
There are different types of seizures, different types of epilepsy syndromes, and different causes of epilepsy. For example, both brain tumors and stroke can cause seizures and lead to chronic epilepsy. Some of the causes can be diagnosed and treated with medicines, and some require surgery.
Epilepsy treatment
The majority of epileptic seizures are controlled with drug therapy, particularly anti-convulsant drugs. The type of treatment prescribed will depend on several factors, including the type of epilepsy (focal/partial versus generalized), the frequency and severity of the seizures, the person’s age, overall health, and medical history. An accurate diagnosis of the type of epilepsy (not just the type of seizure, since most seizure types occur in different types of epilepsy) is critical to choosing the best treatment.
There are many drugs available to treat epilepsy, including:
Phenytoin (Dilantin® or Phenytek®)
Phenobarbital
Carbamazepine (Tegretol® or Carbatrol®)
Primidone (Mysoline®)
Ethosuximide (Zarontin®)
Valproic acid (Depakene®)
Divalproex (Depakote®, Depakote ER®)
Diazepam (Valium®) and related medications such as clonazepam (Klonopin®), and clorazepate (Tranxene®)
Felbamate (Felbatol®)
Gabapentin (Neuronti-n®)
Lamotrigine (Lamictal®)
Tiagabine (Gabitril®)
Topiramate (Topamax®)
Levetiracetam (Keppra®)
Zonisamide (Zonegran®)
Pregabalin (Lyrica®)
In general, for a given type of epilepsy there are only minor differences among appropriate drugs. The choice is most often based on other factors specific to each patient, such as which side effects can be tolerated and which delivery method is acceptable.
Although the different types of epilepsy vary greatly, in general, medicines can control seizures in about 70 percent of epilepsy patients.
It might take several months before the best drug and dosage are determined for you. During this adjustment period, you might be monitored with frequent blood tests. It is very important to keep your follow-up appointments with your doctor and the laboratory to minimize your risk for serious side effects and to prevent complications.
When seizures continue despite treatment for epilepsy, it might be because the episodes thought to be seizures are non-epileptic. In such cases, you should get a second opinion from a specialist and undergo EEG-video monitoring so the diagnosis can be re-evaluated. In specialized centers, about 15 percent to 20 percent of patients referred for persistent, refractory or intractable seizures ultimately prove to have non-epileptic conditions instead.
What are the side effects of epilepsy medicine?
As is true of all drugs, the drugs used to treat epilepsy have side effects. The occurrence of side effects depends on the dose, type of medicine, and length of treatment. The side effects worsen with higher doses but tend to be less severe with time as the body adjusts to the medicine. Anti-epileptic drugs are usually started at lower doses and increased gradually to make this adjustment easier.
Side effects of epilepsy drugs can include blurry or double vision, fatigue, sleepiness, unsteadiness, stomach upset, skin rashes, low blood cell counts, liver problems, swelling of the gums, hair loss, weight gain, and tremor.
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