Proven and effective treatment options
Epilepsy is a disease with proven and effective treatment options. It is the attitude towards epilepsy that may be more disabling than the condition itself. Therefore, patients should be positive, get advice from a qualified doctor, take their medication as prescribed, get the seizures controlled effectively and lead a high-quality disease-free normal day-to-day life with the support of their family and friends.
Dr. Sanjaya Fernando
How is epilepsy treated?
Epilepsy treatment spans beyond mere seizure (fit) control, in offering a complete package for the patient to enrich his/her disease-related quality-of-life.
Seizures can be effectively treated through multiple approaches. Usually medication is the first approach and the commonly prescribed medications are called anti-epileptic drugs (AEDs).
With the right medication, up to 70% of people have their seizures fully controlled.
When is treatment started?
Treatment is only considered after a confident diagnosis of epilepsy has been made, usually after repeated seizures. The decision to start medication is made by a doctor preferably with expertise in epilepsy.
How to start medication?
Generally, treatment starts with a single AED at a low dose, which is increased gradually until the seizures are controlled. If the seizures are not controlled with this drug, a different AED is tried out (by adding the new drug and then slowly withdrawing the first one). If the seizures are not controlled with a single drug, another drug might be added, so that the patient takes two different AEDs each day.
How are AEDs chosen?
The choice of AEDs firstly depends on the type of seizures. Additionally, special precautions are taken while prescribing AEDs to young children, pregnant mothers and the elderly. Most of the AEDs are available free of charge at government hospitals across the country.
How should you take the medication?
Good patient compliance is the key in gaining good seizure control. The AEDs need to be taken as prescribed, daily at regular intervals. It is easier to remember to take the medication if you couple it with your daily routine (eg. brushing the teeth) or assign a member of your family to remind you. Medication-alarms and pill-boxes will also be helpful.
Who should adjust the dose of medication?
The dosage and drug combinations should always be adjusted by a qualified doctor. Changing the medication without advice can lead to extremely deleterious consequences.
Are anti-epileptic medications harmful?
Like all drugs, AEDs can cause side-effects for some. Some of these side-effects go away as the body gets used to the medication or if the dose is adjusted. Patients who take the medication will not become addicted, as erroneously believed by some and neither do they have a greater chance of becoming narcotic abusers in the future.
However, if you have concerns about your medications, you can always talk to your doctor.
How do you come off the treatment?
If someone has not had a seizure for two or more years, then the doctor may consider withdrawing the medication. However, if the patient suddenly stops his/her treatment without seeking advice from the doctor, the seizures may start again or the seizures may get worse, prolonged-continuous, uncontrollable and life-threatening. The doctor would, however, give you a plan on how to come off the medication slowly.
What if the medication can’t control your seizures?
Then your doctor may consider another approach. A ketogenic diet (high fat, low carbohydrate, controlled protein diet) is one such medical treatment. Epilepsy surgery — which involves removing or separating the specific area of the brain which is thought to be firing the seizures to stop or reduce the number of seizures – is another.
(Dr. Fernando is the Consultant Paediatric Neurologist of the Kurunegala Teaching Hospital.)