Seizures Treatment

  • Treatment

    Status epilepticus is a very prolonged seizure, and is a life-threatening emergency that requires immediate medical attention. In status epilepticus, the patient suffers a prolonged seizure or series of seizures and stays unconscious. This condition can arise in a person with epilepsy, or can be triggered by a stroke or metabolic problem in a person with no history of epilepsy. Alcohol-related episodes are sometimes seen in adults, and an infection may trigger the event in a child. Because of the threat of permanent heart damage, brain damage, or death, anyone suffering from status epilepticus should be taken to the emergency room right away.

    Comply with medication. Since seizures may be reduced or not occur while taking medications, patients sometimes think it is not necessary to continue taking their medications on a regular basis especially if they have not experienced a seizure lately. However, consistent drug treatment is critical for treating epilepsy.

    Maintain regular sleep patterns.

    For some patients, seizures are more likely to happen after sleep deprivation or during sleep.

    If you have a history of light-induced seizures, avoid strobe lights and other flashing lights.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Vagus nerve stimulation is a useful therapy in some patients. A small generator is surgically placed into the skin in the chest, and wires are lead to the vagus nerve in the neck. The generator delivers a pulse of electricity to the nerve on a regular basis, or an extra pulse can be given if you sense an aura.

    Drug therapy is unsuccessful in about a third of people with epilepsy. If seizures are severe and recur often enough, surgery is a reasonable option. Surgery involves removing the area of the brain causing the seizures. The most frequently performed epilepsy operation is a procedure in which the temporal lobe of the brain is removed (temporal lobectomy). About 70% of patients who have this procedure are essentially seizure-free afterward. Surgery on other areas of the brain is not as successful.

    Nutritional supplements may help correct deficiencies that play a role in seizures, but they should never be used in place of antiepileptic medications. In rare cases, epilepsy is caused by a B-vitamin deficiency. If your doctor thinks you may not be getting enough of these nutrients from your diet, he or she may recommend that you take supplements.

    Pregnancy usually does not affect the frequency of seizures in women with epilepsy. AEDs increase the risk of fetal malformations. For most women with epilepsy, pregnancy does not present a problem, but in some patients it increases the frequency of seizures, so close monitoring is important. The traditional AEDs (phenytoin, valproate, carbamazepine, and phenobarbital) are associated with an approximately 4% risk of birth defects, compared to a risk of about 1-2% under normal circumstances. Valproate also causes a low rate of birth defects, but unlike the mild, mostly cosmetic defects attributable to the other traditional drugs, it can cause “neural tube defects” such as spina bifida. Therefore, valproate is best avoided during pregnancy, if possible. The risk of continuing an AED must be weighed against the benefits of preventing convulsions, which can cause fetal hypoxia or fetal injury from mother's fall. While most women remain on the lowest effective dose of an AED during pregnancy, you and your doctor will have to decide together whether to stop your AEDs during pregnancy. Any woman who could become pregnant while on an AED should take a folic acid supplement

    Most people are able to control seizure disorders with medications, or, in some cases, surgery. Whether or not seizures are likely to be controlled is highly variable, but depends on the cause of the seizures or the epilepsy syndrome. Nevertheless, two-thirds of patients gain reasonable control with medications. Epilepsy patients with focal-onset seizures who do not respond to antiepileptic drugs usually experience resolution or improvement after surgery. Most patients remain on AEDs after surgery, even if seizures are controlled. However, fewer AEDs or lower doses may be used and even withdrawn eventually.

    Prognosis is good for benign childhood epilepsies. Children with absence seizures due to childhood absence epilepsy have a generally good prognosis: seizures resolve by age 14 in about 70% of these patients. Benign rolandic epilepsy is characterized by partial seizures occurring at night that usually starts between the ages of 5 and 10. Epilepsy resolves and seizures do not recur after age 14 in most of these children.

    Prognosis is poor in a few severe types of epilepsy. Some patients with severe seizures (usually associated with severe mental impairment) may have seizures that do not respond as easily as others. Patients with Lennox-Gastaut syndrome often have frequent and severe seizures that do not respond to conventional therapies. These patients should be referred to a specialty center for diagnosis and treatment.

    Some AEDs (especially older ones) require periodic blood tests to make sure your medications aren't harming your liver, kidneys, or blood cells.

    A family member or close friend should be trained to help in the event that you have a seizure. This person's main responsibility is to protect you from falling and injuring yourself. Other ways someone can help include loosening your collar and placing a pillow under your head. If you lose consciousness, the person should roll you onto your side to help you breathe easier. Contrary to popular belief, it is not possible to “swallow your tongue”. Therefore, nothing should be placed in your mouth, as you could choke on it.

    Wear a bracelet that identifies you as having seizures, and lists any medications you are taking.

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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!

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