By: Priyal Sakhuja
Imagine a large jigsaw
puzzle- all the irregularly shaped pieces scattered on the floor, searching for
the one piece that interlocks perfectly with the next until the entire picture
is made clear. Epilepsy as an illness can be seen as a complex jigsaw puzzle- there
are still pieces of this particular puzzle that need to be pieced together.
Despite the many advances made in science and technology, the human brain
continues to be a mystery for researchers around the world. Although research
on epilepsy is constantly evolving, the current common treatments of epilepsy
have helped to piece together parts of this puzzle.
The first step to treating
epilepsy is with medication. If medication does not prove to be helpful, more
aggressive treatments or surgery may be proposed. Doctors take many factors
into account before prescribing one with anti-epileptic drugs (AEDs) or anticonvulsants.
Some factors that are considered include the type of seizures, the patient’s condition,
frequency of the seizures, age, and a list of other medications the patient may be
taking to ensure that they do not interact with the anti-epileptic medications
(Mayo Clinic, 2013).
Doctors will first prescribe
a single medication at a low dosage and then gradually increase the dosage
until the seizures are under control. Conventional medications used to treat
epilepsy include (WebMD, 2013):
- Dilantin or Phenytek
- Phenobarbital
- Tegretol or Carbatrol
- Mysoline
- Zarontin
- Trileptal
- Keppra
- Depakene
- Depakote, Depakote ER
- Valium and similar tranquilizers, such as Tranxene and Klonopin
Although
the symptoms of the various types of epilepsy differ, these anti-epileptic drugs can generally control seizures in about 70% of patients (WebMD, 2013).
Some
common, predictable, or dose-related side effects, which could occur with any
epilepsy drug include blurriness, double vision, fatigue, sleepiness, and upset
stomach. Meanwhile, more unpredictable reactions that are not dose-related
which could occur include skin rashes, low blood cell counts, and liver
problems (WebMD, 2013).
Although
surgery is not a common treatment option, if seizures are not controlled after
a trial of two medications, surgery
could be suggested. About one third of the 30% of patients whose seizures
cannot be controlled with medication may be able to undergo epilepsy surgery
(WebMD, 2013).
Surgery
is commonly done for seizures that are confined in a small, defined area of the
brain that is not associated with
functions such as speech, language, motor function, vision or hearing. Thus, the doctor removes the area of the patient’s brain that is causing the
seizures (Mayo Clinic, 2013).
Other
therapies that have received attention include the ketogenic diet, which is a
high-fat, low-carb diet. This diet is most useful for children who have not
responded positively to medication. Another treatment that has been used is the
electrical stimulation of the vagus nerve. Minor surgery is required to implant
a stimulator, which is placed under the skin in the upper chest. This therapy
is also used for people who do not respond well to the medications (WebMD).
Studies
on improving treatment options and introducing new therapies for epilepsy
patients are currently underway. Although it will certainly take the piecing together
of many more puzzle pieces to fully understand the mysteries behind epilepsy, the picture will one
day become clear for medical science.
Sources:
Interestingly, my sister’s epilepsy was treated first with high doses and gradually decreased over time. I wonder why this is and whether it has something to do with the fact that she is under a year old.