Epilepsy

Epilepsy (often referred to as a seizure disorder) is a chronic neurological condition characterized by recurrent unprovoked seizures. The condition is named from the Greek epilepsia ("a taking hold of or seizing"). It is commonly controlled with medication, although surgical methods are used as well.

Treatment

Epilepsy is usually treated with medication prescribed by a physician; primary caregivers, neurologists, and neurosurgeons all frequently care for people with epilepsy. In some cases the implantation of a stimulator of the vagus nerve, or a special diet can be helpful. Neurosurgical operations for epilepsy can be palliative, reducing the frequency or severity of seizures; or, in some patients, an operation can be curative.

Related Topics:
Medication - Physician - Primary care - Neurologist - Neurosurgeon - Vagus nerve - Palliative

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Responding to a seizure

In most cases, the proper emergency response to a generalized tonic-clonic epileptic seizure is simply to prevent the patient from self-injury by moving him or her away from sharp edges, placing something soft beneath the head, and carefully rolling the person onto his or her side to avoid asphyxiation. Should the person regurgitate, the material should be allowed to drip out the side of the patient's mouth by itself. If the seizure lasts longer than 5 minutes, Emergency Medical Services should be contacted. Prolonged seizures may develop into status epilepticus, a dangerous condition requiring hospitalization and emergency treatment.

Related Topics:
Head - Asphyxiation - Emergency Medical Services - Status epilepticus

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Objects should never be placed in a person's mouth during a seizure as this could result in injury to the person's mouth or obstruction of the airway. Despite common folklore, it is not possible for a person to swallow their own tongue during a seizure.

Related Topics:
Mouth - Folklore - Tongue

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After a seizure, it is typical for a person to be confused, disoriented, and possibly agitated or sleepy. It is important to stay with the person until this passes; people should not eat or drink until they have returned to their normal level of awareness, and they should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure; this is not dangerous.

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Pharmacologic treatment

Various drugs may prevent seizures or reduce seizure frequency: these include carbamazepine (brand name Tegretol), clobezam (Frisium), clonazepam (Klonopin), ethosuximide (Zarontin), felbamate (Felbatol), fosphenytoin (Cerebyx), flurazepam (Dalmane), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), mephenytoin (Mesantoin), phenobarbital (Luminal), phenytoin (Dilantin), pregabalin (Lyrica), primidone (Mysoline), tiagabine (Gabitril), topiramate (Topamax), valproate, sodium divalproex (Depakene, Depakote), and vigabatrin (Sabril).

Related Topics:
Carbamazepine - Clobezam - Frisium - Clonazepam - Klonopin - Ethosuximide - Zarontin - Felbamate - Felbatol - Fosphenytoin - Cerebyx - Flurazepam - Dalmane - Gabapentin - Neurontin - Lamotrigine - Lamictal - Levetiracetam - Oxcarbazepine - Mephenytoin - Mesantoin - Phenobarbital - Luminal - Phenytoin - Dilantin - Pregabalin - Lyrica - Primidone - Mysoline - Tiagabine - Gabitril - Topiramate - Topamax - Valproate - Vigabatrin - Sabril

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Other drugs are commonly used to abort an active seizure or interrupt a seizure flurry; these include diazepam (Valium) and lorazepam (Ativan). Drugs used only in the treatment of refractory status epilepticus include paraldehyde (Paral) and pentobarbital (Nembutal).

Related Topics:
Diazepam - Valium - Lorazepam - Ativan - Status epilepticus - Paraldehyde - Paral - Pentobarbital - Nembutal

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Bromides were the first of the effective anticonvulsant pure compounds, but are no longer used due to their toxicity and low efficacy.

Related Topics:
Bromides - Toxicity - Efficacy

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Preliminary research suggested that omega-3 fatty acids - particularly docosahexaenoic acid (DHA) - also may be effective in treating epilepsy. A 2005 study by Yuen et al, however, reported no lasting benefit of this therapy.

Related Topics:
Omega-3 fatty acids - Docosahexaenoic acid (DHA)

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Surgical Treatment

Surgical treatment can be an option for epilepsy when an underlying brain abnormality, such as a benign tumor or an area of scar tissue (e.g. hippocampal sclerosis) can be identified. The abnormality must be removable by a neurosurgeon.

Related Topics:
Tumor - Hippocampal sclerosis

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Surgery is usually only offered to patients when their epilepsy has not been controlled by adequate attempts with multiple medications. Before surgery is offered, the medical team performs many tests to assess whether removal of brain tissue will result in unacceptable problems with memory, vision, language or movement, which are controlled by different parts of the brain. Resective surgery, as opposed to palliative, successfully eliminates or significantly reduces seizures in about 80% of the patients who undergo it. Many patients decide not to undergo surgery owing to fear or the uncertainty of having a brain operation.

Related Topics:
Memory - Vision - Language - Movement - Brain

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The most common form of resective surgical treatment for epilepsy is to remove a portion of either the right or left temporal lobe, depending on where the seizures are occurring. A study of 48 patients who underwent this operation, anterior temporal lobectomy, between 1965 and 1974 determined the long-term success of the procedure. Of the 48 patients, 21 had had no seizures that caused loss of conciousness since the operation. Three others had been free of seizures for at least 19 years. The rest had either never been completely free of seizures or had died between the time of the surgery and commencement of the study. (Kelley & Theodore, 2005)

Related Topics:
Temporal lobe - Anterior temporal lobectomy - 1965 - 1974

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Palliative surgery for epilepsy is designed to reduce the frequency or severity of seizures. Examples are callosotomy or commissurotomy, which can prevent seizures from generalizing (spreading to involve the entire brain). Since people whose seizures generalize often lose consciousness and fall over backwards, injuring themselves, this can be quite valuable, especially when the seizures cannot be controlled by other means. Resective surgery is on occasion undertaken with the expectation that it will reduce but not eliminate seizures; this would be considered palliative surgery.

Related Topics:
Palliative - Callosotomy - Commissurotomy

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Hemispherectomy is a drastic operation in which most or all of one half of the cerebral cortex is removed. It is reserved for the most catastrophic epilepsies, such as those due to Rasmussen syndrome. If the surgery is performed on very young patients (2-5 years old), the remaining hemisphere may acquire some rudimentary motor control of the ipsilateral body; in older patients, paralysis results on the side of the body opposite to the part of the brain that was removed. Because of these and other side effects it is usually reserved for patients who have exhausted other treatment options.

Related Topics:
Hemispherectomy - Rasmussen syndrome

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Other Treatment

Ketogenic diets may occasionally be effective in controlling some types of epilepsy; although the mechanism behind the effect is not fully understood, shifting of pH towards a metabolic acidosis and alteration of brain metabolism may be involved. Ketogenic diets are high in fat and extremely low in carbohydrates, with intake of fluids often limited. This treatment, originated as early as the 1920s at Johns Hopkins Medical Center, was largely abandoned with the discovery of modern anti-epileptic drugs, but recently has returned to the anti-epileptic treatment arsenal. Ketogenic diets are sometimes prescribed in severe cases where drugs have proven ineffective.

Related Topics:
Ketogenic diet - PH - Metabolic acidosis - Metabolism - Fat - Carbohydrate - 1920s - Johns Hopkins

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There are several downsides to what initially seems a benign therapy, however. The ketogenic diet is not good for the heart or kidneys and medical problems resulting from the diet have been reported. In addition, the diet is extremely unpalatable and few patients are able to tolerate it for any length of time. Since a single potato chip is adequate to break the ketosis, staying on the diet requires either great willpower or perfect control of a person's dietary intake. People fed via gastrostomy or young children who receive all their food in the presence of a caregiver are better candidates.

Related Topics:
Therapy - Heart - Kidney - Ketosis - Gastrostomy

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Vagus nerve stimulation is a recently developed form of seizure control which uses an implanted electrical device, similar in size, shape and implant location to a heart pacemaker, which connects to the vagus nerve in the neck. Once in place the device can be set to emit electronic pulses, stimulating the vagus nerve at pre-set intervals and milliamp levels. Treatment studies have shown that approximately 50% of people treated in this fashion will show significant seizure reduction.

Related Topics:
Vagus nerve stimulation - Heart pacemaker - Vagus nerve - Neck

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Some people with epilepsy receive a special dog which has the rare talent of sensing the onset of a seizure and is trained to alert the human so they can reach a safe location before their seizure puts them in danger. Other epilepsy care dogs do not sense seizures, but serve as companions and guardians during the loss of consciousness accompanying a seizure.

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