Epilepsy is initially treated with medications. It is possible for up to 70% of people to get complete seizure control with minimal side effects.
For people who have poor seizure control despite trying many different medications over time, there are now other treatment options available.
Medical Management Medication is the first line of treatment in the management of epilepsy. With regular medication and a sensible lifestyle a full and active life is possible.
Surgery for Epilepsy Epilepsy surgery can offer some a chance to be seizure free or significantly reduce the number of seizures. Only certain types of epilepsy are suitable for this treatment.
Vagus Nerve Stimulation (VNS) VNS uses a pacemaker-like device to periodically stimulate the left vagus nerve in the neck to reduce the frequency and intensity of seizures.
Ketogenic Diet A specific diet developed for uncontrolled seizures, particularly in children.
Complementary Therapies Many people are now using alternative or complementary therapies in some way - to improve their health, combat illness and even prolong their life.
Epilepsy today is largely treated with medication. However, these do not cure epilepsy they provide control of seizures only.
Antiepileptic drugs (AEDs) can successfully control up to 70-80% of epileptic seizures. They come in the form of tablets, capsules or syrup.
Most people achieve control with the first medication that is tried, however, some people may need to trial more than one medication before they obtain seizure control.
The choice of medication depends upon factors like seizure type, age, health condition, lifestyle, employment and side effects.
Your doctor will give you instructions on how and when to take the medication and any possible unwanted effects that may occur.
Take your medication as prescribed. Altering dosage or daily routine may provoke unexpected seizures or side effects.
Read the manufacturer's instructions and information.
It is worthwhile discussing with the doctor what to do when doses are missed
Missing tablets may sometimes trigger a seizure. The goal is to keep a constant level of the drug in the bloodstream. If you realise that you have forgotten a dose, take advice from your doctor on what to do.
To avoid missing doses take your medication at a regular time such as meal times
All anti-epileptic medications have side effects. Initially expect a few side effects until your body becomes accustomed to it. Many people find a few weeks after starting medication, the side effects tend to lessen or disappear. If they are related to the dose being too high, they can often be resolved with a reduction in dose.
Sometimes a change of medication is necessary if the effects are an allergic reaction to that particular drug, or unacceptable for the individual.
Some people may have lifelong therapy, whilst others may be able to discontinue the treatment. This will depend on:
Social factors such as education, driving and employment also come into consideration.
Never stop or alter the dose of a drug without medical advice. Any withdrawal from antiepileptic medication should be done slowly and under medical supervision. Suddenly stopping these drugs can provoke a seizure or seizures, often more severe than usual.
If seizures are well controlled, blood tests are seldom necessary. The indications for monitoring blood levels include:
It is important that epilepsy be managed under the guidance of a doctor. Obtain clear instructions how and when to take the medication and what unwanted effects may occur.
Ensure you get adequate sleep and maintain a healthy lifestyle
Younger children may have difficulty swallowing tablets. For information click here.
To report any unusual side-effects of your medication(s), click here
For more details on your particular medication, click here.
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Some people have poor seizure control despite trying a number of medications. There are now other treatment options available to manage epilepsy and seizures.
One of these options is surgery.
Sometimes epilepsy is caused by a small area of abnormal brain tissue. The abnormal tissue may be a result of some form of head injury, brain infection, or abnormal development - which can later turn into scar tissue and become the focus of seizures.
Many people can benefit from surgery - the goal being to stop or significantly reduce seizures without causing any neurological deficits or problems. Surgery is not usually performed unless it is likely the person will obtain a significant benefit.
The most common type of surgery aims to remove the epilepsy focus - or where the seizures start in the brain.
There is a focal onset of the seizures Seizures are of a particularly dangerous or debilitating type (such as drop attacks or status epilepticus) Chronic, generalised seizures occur dozens of times a day, making normal life impossible
Epilepsy programmes for surgery are very extensive and comprehensive, involving a number of tests and prolonged monitoring. Sometimes at the end of the work-up, tests may show that surgery is not possible.
A large range of tests are performed to determine what part of the brain the seizures are originating from. The doctor or staff performing them will properly explain these tests. This is an important time to ask questions.
The tests often include:
Once the entire investigation has been accomplished, a team decision is reached with regard to recommendation for surgery.
Depending on these results, there may be a few further tests to follow.
Making the enormous decision to have surgery can be very stressful for the person with epilepsy and others involved. The need to discuss all the issues associated with such a decision is as important as the surgical procedure itself.
We recommend speaking with your doctor about surgery as an option for you. Epilepsy Action can also be of help with information about surgical options.
Do you want to speak to someone who has had surgery? If so, please email or telephone us for details.
For more comprehensive information about surgery, click here
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This is a relatively new treatment with approval for use in epilepsy in 1997 in the United States. It was registered by the Therapeutic Goods Administration in Australia in April 2000.
VNS Therapy is a mild electrical stimulation of the vagus nerve that runs through the neck and carries information to the brain. Intermittent stimulation of the vagus nerve in some people with epilepsy reduces the frequency and intensity of seizures. It is used as an additional therapy in reducing the frequency of seizures predominantly in adults and adolescents over 12 years of age with focal seizures that are unable to be controlled with antiepileptic medications.
A pacemaker like generator implanted in the chest and a lead is attached to the vagus nerve, which delivers electrical impulses to this nerve at regular intervals. The device is programmed to deliver a regular stimulus to the vagus nerve. If people get a warning or aura before a seizure begins, a magnet can be used to activate the stimulus, which may prevent or reduce the intensity of the seizure.
"How the device works exactly is poorly understood"
Studies have demonstrated an approximate long-term decrease in seizure frequency of 40-50%, and a short-term decrease in seizure frequency of 20-30% in people older than 12 years. "Research has proven that it is a safe and effective way to control seizures"
Many people have reported benefits other than changes in seizure frequency. These benefits include an improvement in alertness, memory, energy levels and mood. It has also allowed many people to reduce the medications they take.
The most common side effects include hoarseness, a prickling feeling on the skin, shortness of breath, and increased coughing. These side effects are often mild and diminish over time.
As with any surgery, there is a small risk of infection and bleeding.
Having a VNS implanted does not mean medications will be stopped. It is usually used in conjunction with medications.
For further information on VNS click here
If you would like to know more ask your specialist.
Vagus Nerve Stimulation is not for everyone and you should check with your Doctor about the suitability of this procedure for you.
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The ketogenic diet, is a specific diet, very high in fats and low in carbohydrates. It makes the body burn fat for energy instead of glucose.
When carefully monitored and controlled, the diet can help two out of three children who are tried on it and may prevent seizures completely in one out of three.
It is a very strict diet, and needs to be closely monitored by a dietician. It takes a strong commitment from the whole family. It is a serious form of treatment that, like other therapies for epilepsy, has side effects that have to be watched for.
Its exact mechanisms are unknown, but more research is being done to learn about the reasons for the diet's positive effect. Studies by a research team at Emory University School of Medicine show that the diet alters genes involved in glucose metabolism in the brain, which in turn helps stabilise the function of neurons exposed to the challenges of epileptic seizures.
Our bodies usually run on energy which we get from glucose in food. Our body can't store large amounts of glucose, and we only have about one days supply.
Sometimes the diet is commenced by a period of fasting, so our body uses up any stored glucose. What happens then is the body begins to run on energy from our fat supplies. When our body burns fat, it creates molecules called ketones. Scientists have understood that these molecules somehow cause a change in metabolism leading to a strong anticonvulsant effect.
The ketogenic diet keeps this process going. It forces the body to burn fat 24 hours a day by making fat products the primary food that the child is getting.
The diet provides most (80 percent) of its energy from fat. The rest comes from carbohydrates and protein. Each meal has about four times as much fat as protein or carbohydrate
The food and liquid at each meal have to be carefully calculated and weighed for each person. It is a very precise method.
Following the ketogenic diet requires a team approach - including doctors, nurses, and especially dieticians specifically trained in the management of people on this diet.
The ketogenic diet is predominantly used in children with poorly controlled seizures. There is no way to predict whether it will be successful or not.
The main indication for the ketogenic diet is the presence of seizures that are difficult to control.
The diet is started under close medical supervision in the hospital. It is started gradually and increased to the full amount over a 3 to 4 day period. During this time blood sugar and ketone levels are monitored. A fasting period is not necessary to start the diet although it is used at some hospitals. More specific information can be found at the Children's Epilepsy Programme
It is difficult to predict. The diet may become effective immediately or can take several months. Each child is unique and has different seizure patterns and frequency. However, there is usually some improvement within the first few weeks on the ketogenic diet. Improvement in behaviour will be also seen in some children.
Medications will continue as normal unless changed by the neurologist. There may be a review of the medications if the diet is successful in controlling the seizures.
Any beliefs that the diet is holistic or all-natural are incorrect. The diet is not without side effects. Gastrointestinal complaints are most common and include constipation and worsening of reflux, diarrhoea and abdominal cramps. Weight loss or gain may also occur. Speak to the doctor about various side effects of this diet.
The diet alone is inadequate in many vitamins and minerals. Supplements will be prescribed for your child while on the ketogenic diet.
If the diet has led to seizure freedom for 2 years, side effects are intolerable, or the family does not feel that the diet is worth the effort, it may be recommended discontinuing the diet. Like discontinuing medications, the diet must be gradually weaned with the supervision of your doctor and dietician.
Childrens Epilepsy Programme - Royal Children's Hospital Melbourne. The Charlie Foundation - Set up by Charlies parents whose seizures were successfully controlled by the diet.
Hans Van der Wiel - has developed a CDROM of tasty and palatable recipes to use. It also has a program to help assists with the equations of measuring foods. Recommended by other parents. Email Hans for details.
References:
Ketogenic Diet Prevents Seizures By Enhancing Brain Energy Production, Increasing Neuron Stability
Saurabh R. Sinha, MD, PhD, and Eric H. Kossoff, MD. The Ketogenic Diet. The Neurologist Volume 11, Number 3, May 2005
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Many Australians are now using complementary therapies in some way to improve their health, combat illness or even prolong their lives.
In the 1930s the management of epilepsy was revolutionised with the advent of effective antiepileptic drugs (AEDs). There have been many scientific advances in the understanding and treatment of epilepsy and a raft of antiepileptic medication have become readily available in the Western world since that time.
Today, many people with epilepsy are well-controlled on medication with minimal side effects and live full and active lives. However, about 30% of people with epilepsy continue to struggle with seizure control or experience side effects that impact their long- term health or quality of life.
It is understandable that people search for alternatives to medication whether it is within conventional medicines, such as surgery, implantation of electrical devices and use of the ketogenic diet, or in the less conventional or alternative therapeutic areas. People with epilepsy around the world have tried many alternative or complimentary therapies; however, few of these therapies have been rigorously tested against the scientific standards used to assess the effectiveness and safety of conventional medications or treatments.
Just because its natural doesnt mean its safe. Any herb or alternative medication is a drug, whether its ingested, inhaled or applied topically.
Doctors Orrin Devinsky, Steven Schachter and Steven Pacia, well-respected neurologists and acedemics, have brought together experts in the various fields of alternative and complimentary therapies to discuss the treatment of epilepsy and the supporting evidence in the book Complimentary and Alternative Therapies for Epilepsy. The book explores therapies ranging from stress management, EEG Neural Feedback, traditional Indian and Chinese therapies to transcranial magnetic stimulation, osteopathic, herbal and nutritional therapies.
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Conventional medicine is currently focusing on antiepileptic drug-induced nutrition deficiencies, such as vitamin B6, calcium, vitamin D and folic acid. It is well known that long-term use of antiepileptic medication affects bone mineral density and increases the risk of osteoporotic fractures. However, the short-term effects were not well-defined.
In 2008, a study published in Neurology looked specifically at the short-term risk of reduced bone mineral density associated with specific AEDs over a one year period. The researchers measured bone mineral density of the lumbar spine and hip as well as markers of bone turnover and serum calciotropic hormone levels in 93 pre-menopausal women on mono therapy (one medication).
Researchers discovered a significant decline in bone mineral density of the hip after only one year for women on phenytoin (Dilantin). However, they could see no measurable difference for women on carbamazepine, lamotrigine or valproate. Although the mechanism of phenytoin-induced bone loss is not known, lower vitamin D levels were associated with secondary hyperparathyroidism and higher bone resorption in this group. The researcher suggested supplementation of vitamin D and calcium as well as the addition of weight bearing exercises.
Jane Sala Tenna, a naturopath and qualified member of the Australian Natural Therapists Association (ANTA) based in Perth, has long recommended the monitoring of vitamin D levels and supplementation as required. People need to be more well-informed about the issue so they can get the care they need to avoid the long-term effects later in life, she says.
Many people are on numerous combinations of AEDs. Each medication will have a different impact on different nutrients, Jane says, explaining that each person will therefore need an individual assessment of their nutritional status. Combining alternative and conventional treatments can be complex. It is important for people planning on trying alternative, complimentary, herbal or nutritional therapies to consult with their doctor or neurologist first.
Never stop taking anti-epileptic medication suddenly or attempt to alter the dosage on your own. This can lead to serious or life threatening seizures.
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The depletion of vital vitamin and minerals caused by AEDs can have a short and long-term health risk for people, particularly those who are on multiple and long-term therapy, Jane explains.
The question remains as to whether an integrated program of drug therapy and nutritional support would improve health overall and possibly even decrease severity and frequency of seizures, she says. Management will require monitoring by regular blood tests, ordered by a professional who has experience in nutritional therapy.
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