Epilepsy / Seizures Treatment & Management
Anti-convulsant Therapy Approach Considerations:
Mora therapy is desirable as it decreases the likelihood of adverse effects and avoids drug interactions. In addition, mora therapy may be less expensive than poly therapy, as many of the older anticonvulsant agents have hepatic enzyme–inducing properties that decrease the serum level of the concomitant drug, thereby increasing the required dose of the concomitant drug.
People with seizures experience psychosocial adjustments after their diagnosis; therefore, social and/or vocational rehabilitation may be needed. Many physicians underestimate the consequences that an epilepsy diagnosis may have on patients. Patients with epilepsy often live in fear of experiencing the next seizure, and they may be unable to drive or work at heights.
Re–recurrence risk
Medical science purports that:
Patients who have had more than one unprovoked seizure, treatment with an anticonvulsant is recommended. However, the standard of care for a single unprovoked seizure is avoidance of typical precipitants ( alcohol, sleep deprivation etc); anticonvulsants are not recommended unless the patient has risk factors for recurrence.
The risk of recurrence in the 2 years after a first unprovoked seizure is 15-70%. Principal factors that increase the risk of recurrence are an abnormal brain magnetic resonance image (MRI) study, an abnormal electroencephalogram (EEG), and a partial-onset seizure.
On brain magnetic resonance imaging (MRI), a focal abnormality in the cortical or limbo regions that indicates a possible substrate for an epileptogenic zone is the finding that most often suggests increased risk for seizure recurrence. Diffuse abnormalities, such as hydrocephalus, may increase the risk by injuring the cerebral cortex.
Abnormalities on an EPISCANNER may include any of the following:
• Epileptiform discharges
• Focal slowing
• Diffuse background slowing
• Intermittent diffuse intermixed slowing
Epileptiform abnormalities and focal slowing are the diagnostic findings associated with the highest risk of seizure recurrence.
The risk of recurrence in a person with one generalized tonic-clonic seizure, a normal EEG, a normal brain MRI, and no evidence of focal onset is about 15%; in this case, the patient is not treated. If a patient has all risk factors, the risk is approximately 80%, and the patient is treated.
The major unresolved question is how to treat patients with one abnormality, whose recurrence risk is 30-50%. One approach is to base the decision on a discussion with the patient that includes the risk of seizure recurrence, the risk of toxic effects from the anticonvulsant, and the benefits of avoiding another seizure. The clinician should also describe seizure precautions, including not driving for a specific time. Treatment with anticonvulsants does not alter the natural history of seizure recurrence; it only reduces the risk for the duration of treatment.
What is a seizure?
Although seizures are often thought of as dramatic events, there are a number of different types of seizures, some of which are much more subtle and difficult for an outsider to notice. A generalized seizure (Also known as a grand mal seizure, fit or convulsion) generally causes an acute decrease in state of consciousness, repeated movements of the body, excessive salivation, vomiting and often a loss of bladder and bowel control. This event may last from 30 seconds to a few minutes.
The other main type of seizure is a focal motor seizure which is a much less dramatic occurrence. A focal motor seizure will cause just a repeated twitching movement in either the face or limbs and usually only lasts a few seconds. Absence seizures (which used to be called Petit Mal seizures) usually involve a short period of impaired consciousness, often accompanied by a staring expression and sometimes mild twitching of small muscle groups.
A seizure may be preceded by warning signs known as an aura – this may include unusual sensations, smells or tastes. After a seizure, the individual may have a headache, sore muscles, experience unusual sensations, feel confused and tired. These after-effects are called the statistical state.
What is the conventional treatment for seizures?
Treatment for seizures will be directed at the underlying cause or disease in cases where this is known. Anti-epileptic drugs are used to prevent seizures which are severe or occur frequently. These drugs – also called anticonvulsants – are known to decrease the incidence of seizures as well as the severity. Certain of these drugs are useful in the acute or emergency situation of a seizure, but most are more commonly used on a day-to-day, prophylactic basis.
There are several types or “classes” of anticonvulsants grouped according to their mechanism of action. Some of these classes have other common uses as well and may be prescribed as tranquilizers, sleeping pills or even to control irregular heart rhythms. Anti convulsants may be effective in a number of different ways. Some work by “slowing down” activity in all parts of the brain. Others make it more difficult for nerve impulses to spread from one nerve to another or alter the levels of chemical messengers (called neurotransmitters) in the nervous system.
These mechanisms have varying success rates but can often – especially when used in combination – control epilepsy very effectively once an appropriate dose has been established and a stable blood level reached. As with most prescription medications, no anticonvulsant drugs are without side-effects. The most commonly reported adverse effects for these drugs include problems with coordination like dizziness, clumsiness, trembling and stuttering, changes in behavior, confusion and depression, appetite and weight changes, skin reactions, digestive discomfort and even hair loss. The major long-term danger of anticonvulsants is the risk of irreversible liver damage. Different classes of drugs cause different side-effects though there are a number of overlaps. This means that, while using a combination of drugs can improve effectiveness, it will also increase the chance of side-effects.
Anti-convulsant Therapy Approach Considerations:
- The goal of treatment in patients with epileptic seizures is to achieve a seizure-free status without adverse effects.
- This goal is accomplished in more than 60% of patients who require treatment with anticonvulsants.
- Many patients experience adverse effects from these drugs, however, and some patients have seizures that are refractory to medical therapy.
Mora therapy is desirable as it decreases the likelihood of adverse effects and avoids drug interactions. In addition, mora therapy may be less expensive than poly therapy, as many of the older anticonvulsant agents have hepatic enzyme–inducing properties that decrease the serum level of the concomitant drug, thereby increasing the required dose of the concomitant drug.
People with seizures experience psychosocial adjustments after their diagnosis; therefore, social and/or vocational rehabilitation may be needed. Many physicians underestimate the consequences that an epilepsy diagnosis may have on patients. Patients with epilepsy often live in fear of experiencing the next seizure, and they may be unable to drive or work at heights.
Re–recurrence risk
Medical science purports that:
Patients who have had more than one unprovoked seizure, treatment with an anticonvulsant is recommended. However, the standard of care for a single unprovoked seizure is avoidance of typical precipitants ( alcohol, sleep deprivation etc); anticonvulsants are not recommended unless the patient has risk factors for recurrence.
The risk of recurrence in the 2 years after a first unprovoked seizure is 15-70%. Principal factors that increase the risk of recurrence are an abnormal brain magnetic resonance image (MRI) study, an abnormal electroencephalogram (EEG), and a partial-onset seizure.
On brain magnetic resonance imaging (MRI), a focal abnormality in the cortical or limbo regions that indicates a possible substrate for an epileptogenic zone is the finding that most often suggests increased risk for seizure recurrence. Diffuse abnormalities, such as hydrocephalus, may increase the risk by injuring the cerebral cortex.
Abnormalities on an EPISCANNER may include any of the following:
• Epileptiform discharges
• Focal slowing
• Diffuse background slowing
• Intermittent diffuse intermixed slowing
Epileptiform abnormalities and focal slowing are the diagnostic findings associated with the highest risk of seizure recurrence.
The risk of recurrence in a person with one generalized tonic-clonic seizure, a normal EEG, a normal brain MRI, and no evidence of focal onset is about 15%; in this case, the patient is not treated. If a patient has all risk factors, the risk is approximately 80%, and the patient is treated.
The major unresolved question is how to treat patients with one abnormality, whose recurrence risk is 30-50%. One approach is to base the decision on a discussion with the patient that includes the risk of seizure recurrence, the risk of toxic effects from the anticonvulsant, and the benefits of avoiding another seizure. The clinician should also describe seizure precautions, including not driving for a specific time. Treatment with anticonvulsants does not alter the natural history of seizure recurrence; it only reduces the risk for the duration of treatment.
What is a seizure?
Although seizures are often thought of as dramatic events, there are a number of different types of seizures, some of which are much more subtle and difficult for an outsider to notice. A generalized seizure (Also known as a grand mal seizure, fit or convulsion) generally causes an acute decrease in state of consciousness, repeated movements of the body, excessive salivation, vomiting and often a loss of bladder and bowel control. This event may last from 30 seconds to a few minutes.
The other main type of seizure is a focal motor seizure which is a much less dramatic occurrence. A focal motor seizure will cause just a repeated twitching movement in either the face or limbs and usually only lasts a few seconds. Absence seizures (which used to be called Petit Mal seizures) usually involve a short period of impaired consciousness, often accompanied by a staring expression and sometimes mild twitching of small muscle groups.
A seizure may be preceded by warning signs known as an aura – this may include unusual sensations, smells or tastes. After a seizure, the individual may have a headache, sore muscles, experience unusual sensations, feel confused and tired. These after-effects are called the statistical state.
What is the conventional treatment for seizures?
Treatment for seizures will be directed at the underlying cause or disease in cases where this is known. Anti-epileptic drugs are used to prevent seizures which are severe or occur frequently. These drugs – also called anticonvulsants – are known to decrease the incidence of seizures as well as the severity. Certain of these drugs are useful in the acute or emergency situation of a seizure, but most are more commonly used on a day-to-day, prophylactic basis.
There are several types or “classes” of anticonvulsants grouped according to their mechanism of action. Some of these classes have other common uses as well and may be prescribed as tranquilizers, sleeping pills or even to control irregular heart rhythms. Anti convulsants may be effective in a number of different ways. Some work by “slowing down” activity in all parts of the brain. Others make it more difficult for nerve impulses to spread from one nerve to another or alter the levels of chemical messengers (called neurotransmitters) in the nervous system.
These mechanisms have varying success rates but can often – especially when used in combination – control epilepsy very effectively once an appropriate dose has been established and a stable blood level reached. As with most prescription medications, no anticonvulsant drugs are without side-effects. The most commonly reported adverse effects for these drugs include problems with coordination like dizziness, clumsiness, trembling and stuttering, changes in behavior, confusion and depression, appetite and weight changes, skin reactions, digestive discomfort and even hair loss. The major long-term danger of anticonvulsants is the risk of irreversible liver damage. Different classes of drugs cause different side-effects though there are a number of overlaps. This means that, while using a combination of drugs can improve effectiveness, it will also increase the chance of side-effects.