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SEIZURE DISORDER TREATMENTS |
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The goal of epilepsy treatment is to
eliminate seizures or make the symptoms less frequent and less
severe. Long-term anticonvulsant drug therapy is the most common
form of epilepsy treatment. Medication A combination of drugs may be needed to control some symptoms, but most patients who have epilepsy take one of the following medications: Dilantin (phenytoin) Tegretol (carbamazepine) Barbita (phenobarbital) Mysoline (primidone) Depakene (valproic acid, sodium valproate) Klonopin (clonazepam) Zarontin (ethosuximide). Dilantin, Tegretol, Barbita, and Mysoline are used to manage or control generalized tonic-clonic and complex partial seizures. Depakene, Klonopin, and Zarontin are prescribed for patients who have absence seizures. Neurontonin (gabapentin) and Lamictal (lamotrigine) are medications recently approved in the United States to treat adults who have partial seizures or partial and grand mal seizures. Even a patient whose seizures are well controlled should have regular blood tests to measure levels of anti-seizure medication in his system and to check to see if the medication is causing any changes in his blood or liver. A doctor should be notified if any signs of drug toxicity appear, including uncontrolled eye movements; sluggishness, dizziness, or hyperactivity; inability to see clearly or speak distinctly; nausea or vomiting; or sleep problems. Status epilepticus requires emergency treatment, usually with Valium (Ativan), Dilantin, or Barbita. An intravenous dextrose (sugar) solution is given to patients whose condition is due to low blood sugar, and a vitamin B1 preparation is administered intravenously when status epilepticus results from chronic alcohol withdrawal. Because dextrose and thiamine are essentially harmless and because delay in treatment can be disastrous, these medications are given routinely, as it is usually difficult to obtain an adequate history from a patient suffering from status epilepticus. Intractable seizures are seizures that cannot be controlled with medication or without sedation or other unacceptable side effects. Surgery may be used to eliminate or control intractable seizures. Surgery Surgery can be used to treat patients whose intractable seizures stem from small focal lesions that can be removed without endangering the patient, changing the patient's personality, dulling the patient's senses, or reducing the patient's ability to function. Each year, as many as 5,000 new patients may become suitable candidates for surgery, which is most often performed at a comprehensive epilepsy center. Potential surgical candidates include patients with: Partial seizures and secondarily generalized seizures (attacks that begin in one area and spread to both sides of the brain). Seizures and childhood paralysis on one side of the body (hemiplegia). Complex partial seizures originating in the temporal lobe (the part of the brain associated with speech, hearing, and smell) or other focal seizures. However, the risk of surgery involving the speech centers is that the patient will lose speech function. Generalized myoclonic seizures or generalized seizures featuring temporary paralysis (akinetic) or loss of muscle tone (atonal). A physical examination is conducted to verify that a patient's seizures are caused by epilepsy, and surgery is not used to treat patients with severe psychiatric disturbances or medical problems that raise risk factors to unacceptable levels. Surgery is never indicated unless: The best available anti-seizure medications have failed to control the patient's symptoms satisfactorily. The origin of the patient's seizures has been precisely located. There is good reason to believe that surgery will significantly improve the patient's health and quality of life. Every patient considering epilepsy surgery is carefully evaluated by one or more neurologists, neurosurgeons, neuropsychologists, and/or social workers. A psychiatrist, chaplain, or other spiritual advisor may help the patient and his family cope with the stresses that occur during and after the selection process. Types of surgery Surgical techniques used to treat intractable epilepsy include: Lesionectomy. Removing the lesion (diseased brain tissue) and some surrounding brain tissue is very effective in controlling seizures. Lesionectomy is generally more successful than surgery performed on patients whose seizures are not caused by clearly defined lesions, but removing only part of the lesion lessens the effectiveness of the procedure. Temporal resections. Removing part of the temporal lobe and the part of the brain associated with feelings, memory, and emotions (the hippocampus) provides good or excellent seizure control in 75-80% of properly selected patients with appropriate types of temporal lobe epilepsy. Some patients experience post-operative speech and memory problems. Extra-temporal resection. This procedure involves removing some or all of the frontal lobe, the part of the brain directly behind the forehead. The frontal lobe helps regulate movement, planning, judgment, and personality, and special care must be taken to prevent post-operative problems with movement and speech. Extra-temporal resection is most successful in patients whose seizures are not widespread. Hemispherectomy. This method of removing brain tissue is restricted to patients with severe epilepsy and abnormal discharges that often extend from one side of the brain to the other. Hemispherectomies are most often performed on infants or young children who have had an extensive brain disease or disorder since birth or from a very young age. Corpus callosotomy. This procedure, an alternative to hemispherectomy in patients with congenital hemiplegia, removes some or all of the white matter that separates the two halves of the brain. Corpus callosotomy is performed almost exclusively on children who are frequently injured during falls caused by seizures. If removing two-thirds of the corpus callosum doesn't produce lasting improvement in the patient's condition, the remaining one-third will be removed during another operation. Multiple subpial transection. This procedure is used to control the spread of seizures that originate in or affect the "eloquent" cortex, the area of the brain responsible for complex thought and reasoning. Other forms of treatment Ketogenic diet A special high-fat, low-protein, low-carbohydrate diet is sometimes used to treat patients whose severe seizures have not responded to other treatment. Calculated according to age, height, and weight, the ketogenic diet induces mild starvation and dehydration. This forces the body to create an excessive supply of ketones, natural chemicals with seizure-suppressing properties. The goal of this controversial approach is to maintain or improve seizure control while reducing medication. The ketogenic diet works best with children between the ages of one and 10. It is introduced over a period of several days, and most children are hospitalized during the early stages of treatment. If a child following this diet remains seizure-free for at least six months, increased amounts of carbohydrates and protein are gradually added. If the child shows no improvement after three months, the diet is gradually discontinued. Introduced in the 1920s, the ketogenic diet has had limited, short-term success in controlling seizure activity. Its use exposes patients to such potentially harmful side effects as: Staphylococcal infections Stunted or delayed growth Low blood sugar (hypoglycemia) Excess fat in the blood (hyperlipidemia) Disease resulting from calcium deposits in the urinary tract (urolithiasis) Disease of the optic nerve (optic neuropathy). Vagus nerve stimulation The United States Food and Drug Administration (FDA) has approved the use of vagus nerve stimulation (VNS) in patients over the age of 16 who have intractable partial seizures. This non-surgical procedure uses a pacemaker-like device implanted under the skin in the upper left chest, to provide intermittent stimulation to the vagus nerve. Stretching from the side of the neck into the brain, the vagus nerve affects swallowing, speech, breathing, and many other functions, and VNS may prevent or shorten some seizures. First aid for seizures A person having a seizure should not be restrained, but sharp or dangerous objects should be moved out of reach. Anyone having a complex partial seizure can be warned away from danger by someone calling his/her name in a clear, calm voice. A person having a grand mal seizure should be helped to lie down. Tight clothing should be loosened. A soft, flat object like a towel or the palm of a hand should be placed under the person's head. Forcing a hard object into the mouth of someone having a grand mal seizure could cause injuries or breathing problems. If the person's mouth is open, placing a folded cloth or other soft object between his teeth will protect his tongue. Turning his head to the side will help him breathe. After a grand mal seizure has ended, the person who had the seizure should be told what has happened and reminded of where he is. Alternative treatment Stress increases seizure activity in 30% of people who have epilepsy. Relaxation techniques can provide some sense of control over the disorder, but they should never be used instead of anti-seizure medication or used without the approval of the patient's doctor. Yoga, meditation, and favorite pastimes help some people relax and manage stress more successfully. Biofeedback can teach adults and older adolescents how to recognize an aura and what to do to stop its spread. Children under 14 are not usually able to understand and apply principles of biofeedback. Acupuncture treatments (acupuncture needles inserted for a few minutes or left in place for as long as half an hour) make some people feel pleasantly relaxed. Acupressure can have the same effect on children or on adults who dislike needles. Aromatherapy involves mixing aromatic plant oils into water or other oils and massaging them into the skin or using a special burner to waft their fragrance throughout the room. Aromatherapy oils affect the body and the brain, and undiluted oils should never be applied directly to the skin. Ylang ylang, chamomile, or lavender can create a soothing mood. People who have epilepsy should not use rosemary, hyssop, sage or sweet fennel, which seem to make the brain more alert. Dietary changes that emphasize whole foods and eliminate processed foods may be helpful. Homeopathic therapy also can work for people with seizures, especially constitutional homeopathic treatment that acts at the deepest levels to address the needs of the individual person. |
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