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Medical Management of Epilepsy

Medical Management of Epilepsy

Epilepsy is a condition that causes seizures, temporary episodes that often include twitching and convulsions. These seizures happen when the brain's electrical impulses act abnormally and send erratic signals. Think of it as your brain getting confused by these haywire messages, and the result is a seizure.

Epilepsy can make driving, walking across the street, or cooking dinner a dangerous activity because you never know when a seizure may strike. But epilepsy can usually be managed well through medication and other treatments. Learning how to reduce your risk for a seizure through lifestyle changes and learning your triggers can also help you to better manage your epilepsy.

Facts about the medical management of epilepsy

About 70 percent of people with epilepsy are able to successfully manage epilepsy seizures with medication and certain types of surgery, but it’s important to remember that epilepsy can't be cured and that there's always a risk of having another seizure.

Epilepsy usually begins in young people, often between ages 5 and 20, although it can affect anyone. Most of the time, people with epilepsy have someone else in their family who has epilepsy or seizures.

Sometimes seizures can be triggered by something that's out of your control. Running a high fever may result in a seizure, despite taking medications to manage epilepsy. Having high or low blood glucose or sodium or taking certain medications can also cause a seizure.

Symptoms of epilepsy

The primary symptom of epilepsy is a seizure. But there are different types of seizures with different symptoms. These are some symptoms of seizures:

  • Slight twitching of all or parts of the body, including arms, hands, and legs

  • Convulsions that affect the entire body

  • Loss of consciousness

  • Twitching of the face

  • Affected speech

  • Sudden stillness with a blank stare

  • Temporary loss of control of your bladder or bowels 

Most seizures only last for a few minutes or even just a few seconds. If you've had a seizure, it may take you an hour or so to feel normal again. And you may not have any memory of having had a seizure or remember what was happening as the seizure started.

Diagnosis

A doctor may perform a neurological exam and a complete physical exam to pinpoint the cause of the seizures and diagnose epilepsy. Tests used to diagnose epilepsy include:

  • An electroencephalogram (EEG) to measure the electrical activity of the brain

  • A spinal tap to collect spinal fluid for analysis

  • Imaging tests, like an MRI or CT scan, of the head

These blood tests are also commonly used to help diagnose epilepsy or rule out other disorders: 

  • Tests of liver and kidney function

  • Blood glucose tests

  • Complete blood count and chemistry of the blood

  • Tests to diagnose or rule out any infectious diseases

Treatment

Epilepsy can be treated through multiple strategies. Usually medication is needed to control seizures and treat epilepsy; these commonly prescribed drugs are called anticonvulsants.

Medication alone can't always stop or reduce seizures. A device called a vagus nerve stimulator may help treat epilepsy if you don’t get relief from medication. The stimulator is surgically placed in the chest. It electrically stimulates a large nerve (the vagus nerve) that runs through the neck. This device is successful in preventing seizures in some people, but even a vagus nerve stimulator can't totally stop seizures from happening.

Some doctors recommend a special diet high in fat and low in carbohydrates to help manage epilepsy. This is called a ketogenic diet, and it may help more than half of people who haven't improved on medicine alone.

If you can't get good control over seizures with medications, diet, or a vagus nerve stimulator, brain surgery to correct the problem might be an option.

Calling the doctor

If you have a seizure for the first time, you should see a doctor right away to try to pinpoint the cause. If you have already been diagnosed with epilepsy, tell your doctor about any changes in your seizures; it's a good idea to keep track of when and where they occur and contact your doctor as recommended.

Prevention

Although there is no way to prevent epilepsy, you can take steps to help prevent seizures:

  • Don't drink alcohol, use illegal drugs, or smoke.

  • Protect your head with a helmet during any sport or activity that could result in a head injury.

  • Get plenty of sleep every night.

  • Do your best to avoid getting a cold or the flu.

  • Talk with your doctor about all of your prescription medications to be sure they won't aggravate seizures.

  • Always take all of your epilepsy medications as prescribed.

  • Find healthy ways to cope with stress.

Complications

Epilepsy can lead to emotional and social problems, particularly in children. They may start to act out, experience behavior problems at school, or develop a learning disability. The seizures themselves can cause injury if you fall or hit your head or if you happen to be driving or using machinery. Other complications include suffering permanent damage to the brain due to lack of oxygen during a seizure.

Medications used to treat epilepsy may cause complications or uncomfortable side effects. If you're pregnant, some of these drugs may lead to serious birth defects. 

Key points to remember

Because a seizure can strike at any time, do your best to be prepared. If you have uncontrolled seizures, don’t drive to reduce your risk of being in an accident. Ask your doctor about wearing a medical alert bracelet that identifies you as having epilepsy so that people will know what to do if you have a seizure. And if you're pregnant or trying to become pregnant, remember to check with your doctor about the safety of your medications.

 
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