Treatment procedures for epilepsy

Epilepsy medication

Epilepsy requires medical intervention in order to treat the condition. Top of the list is usually prescribed medication. Medications are essential for helping to control symptoms and prevent seizures or decrease the intensity of the incidents experienced.

The purpose of prescribed medication is not typically to control or stop a seizure already in progress. Neither is medication prescribed in an attempt to ‘cure’ the condition. Currently there is no cure for epilepsy.

Medication is produced to be absorbed by the stomach, enabling it to easily travel through the bloodstream into the brain. It is then able to affect the brain’s neurotransmitters and reduce the electrical activity that causes a seizure. The medication can then pass through the digestive tract and be passed out of the body through urine.

Dosages will be controlled and your condition frequently monitored. You may be prescribed medications in tablet, liquid or injectable forms to be taken at specific or multiple times each day. There may even come a time when your doctor may feel that you can stop taking medications altogether.

Many individuals, especially children with epilepsy, who haven’t experienced symptoms for a period of time may be able to discontinue medicinal treatment and live a relatively seizure-free life. If, as an adult, you have not had a seizure for more than 2 years, you may also be able to discontinue medicinal treatment.

The type of medication and dosage may take a little trial and error to get right at first, not only to control your seizures but also taking into consideration the type of side-effects the medications will likely cause. One medication at a low dosage may be prescribed at first and gradually adjusted until it is determined that your seizures are under control. Your doctor will carefully assess your overall condition, the type and frequency of seizures you’ve experienced thus far, if you need to take other medications to treat other symptoms or conditions, and your age before prescribing any medication to you.

Mild side-effects are common and may include symptoms of fatigue, weight fluctuations (either gain or loss), dizziness, loss of bone density, impaired coordination, skin rashes, memory dysfunction and speech problems. Rare, but more severe medication side-effects can include dramatic emotional and mental changes relating to depression and suicidal thoughts and behaviours, as well as inflammation of vital organs (such as the liver) and skin rashes.

Medication is currently the best means of getting epilepsy and seizures under control. It is vitally important that you take your medication exactly as prescribed by your doctor and never try and self-treat your condition. There are generic versions of some medications. It is strongly advised that you check with your doctor before taking any generic versions available or any other prescribed or over-the-counter drugs (including herbal supplements) as well. These could interfere with your treatment and cause adverse reactions.

If you experience any unusual or dramatic changes to your mood or behaviour, or experience migraines, you must consult your doctor as soon as possible.

Surgery for epilepsy

Surgery is another option that may be discussed with you taking into consideration the results of some of the tests that may have been performed. The most common surgery is known as a ‘resection’. If in the testing process, your doctor was able to determine a cause of your seizures in a well-defined area of your brain that will not likely interfere with vital functions (such as language and speech, vision, hearing or motor function), surgery may be recommended to remove that area of the brain (often the temporal lobe) or obstruction.

If it is picked up that seizures originate in areas that do affect vital function, surgery can still be recommended but it may happen that you will be awake during a portion of the actual procedure so that your doctor can ask you specific questions while operating.

It can happen that the affected area of the brain is too big or vital to remove. In this instance, a doctor may recommend a surgical procedure called a ‘multiple subpial transection’ (or disconnection) which interrupts the nerve pathway in the brain. The purpose of this surgery is to help reduce the likelihood of the origin of your seizures spreading to other areas of the brain.

Following surgery, medications to prevent seizures may still be prescribed even if the procedure was successful. Dosages may be lower and less frequently taken.

As with any surgery, there are risks and complications that can occur as a direct result. Some complications can include adverse reactions to general anaesthetic, infections or bleeding. Surgery can also permanently alter your cognitive abilities (ability to think). Your doctor will discuss any risks with you before any surgery is performed, so that you are well-informed about what can happen.

Other epilepsy treatment options

Your doctor may opt to recommend implanting a vagus nerve stimulator beneath the skin in your chest. This device is similar to a heart pacemaker, with wires that are connected to the vagus nerve in the neck. The device is battery powered and delivers bursts of electrical energy through the nerve, and on to the brain. It has been noted that this device can help to reduce seizures by between 20 and 40% in many epileptic individuals.

Vagus nerve stimulation will still be used in conjunction with medication treatment, but as a result, the doctor may be able to prescribe lower and less frequent doses. Side-effects from the implanted device can include coughing, shortness of breath, pain in the throat and a hoarse voice.

Potentially effective treatments for future use are in the process of being researched and tested. These involve deep brain stimulation (brain implanted electrodes connected to an implanted generator in the chest or skull which send electrical pulses to the brain), an epilepsy pacemaker (responsive stimulation or ‘closed-loop’ devices), MRI-guided laser ablation and stereotactic radiosurgery.