Seizure disorder

Encyclopedia of Medicine, Apr 06, 2001 by Maureen Haggerty

The goal of epilepsy treatment is to eliminate seizures or make the symptoms less frequent and less severe. Long-term anticonvulsant drug therapy is the most common form of epilepsy treatment.

A combination of drugs may be needed to control some symptoms, but most patients who have epilepsy take one of the following medications:

• Dilantin (phenytoin)
• Tegretol (carbamazepine)
• Barbita (phenobarbital)
• Mysoline (primidone)
• Depakene (valproic acid, sodium valproate)
• Klonopin (clonazepam)
• Zarontin (ethosuximide).

Dilantin, Tegretol, Barbita, and Mysoline are used to manage or control generalized tonic-clonic and complex partial seizures. Depakene, Klonopin, and Zarontin are prescribed for patients who have absence seizures.

Neurontonin (gabapentin) and Lamictal (lamotrigine) are medications recently approved in the United States to treat adults who have partial seizures or partial and grand mal seizures.

Even a patient whose seizures are well controlled should have regular blood tests to measure levels of anti-seizure medication in his system and to check to see if the medication is causing any changes in his blood or liver. A doctor should be notified if any signs of drug toxicity appear, including uncontrolled eye movements; sluggishness, dizziness, or hyperactivity; inability to see clearly or speak distinctly; nausea or vomiting; or sleep problems.

Status epilepticus requires emergency treatment, usually with Valium (Ativan), Dilantin, or Barbita. An intravenous dextrose (sugar) solution is given to patients whose condition is due to low blood sugar, and a vitamin B1 preparation is administered intravenously when status epilepticus results from chronic alcohol withdrawal. Because dextrose and thiamine are essentially harmless and because delay in treatment can be disastrous, these medications are given routinely, as it is usually difficult to obtain an adequate history from a patient suffering from status epilepticus.

Intractable seizures are seizures that cannot be controlled with medication or without sedation or other unacceptable side effects. Surgery may be used to eliminate or control intractable seizures.

Surgery can be used to treat patients whose intractable seizures stem from small focal lesions that can be removed without endangering the patient, changing the patient's personality, dulling the patient's senses, or reducing the patient's ability to function.

Each year, as many as 5,000 new patients may become suitable candidates for surgery, which is most often performed at a comprehensive epilepsy center. Potential surgical candidates include patients with:

• Partial seizures and secondarily generalized seizures (attacks that begin in one area and spread to both sides of the brain).
• Seizures and childhood paralysis on one side of the body (hemiplegia).
• Complex partial seizures originating in the temporal lobe (the part of the brain associated with speech, hearing, and smell) or other focal seizures. However, the risk of surgery involving the speech centers is that the patient will lose speech function.
• Generalized myoclonic seizures or generalized seizures featuring temporary paralysis (akinetic) or loss of muscle tone (atonal).