Epilepsy Treatment made easy- Everything you need to know!!

There are many things a provider and person with epilepsy can do to stop or lessen seizures.

The most common treatments for epilepsy are:

•  Seizure medication also called Anti-seizure drugs or anti-epileptic drugs are medicines that limit the spread of electrical activity in the brain. The neurologist will change the seizure medicine dose or prescribe a new drug if needed for the best treatment of epilepsy. Seizure Medicines work for about 2 in 3 patients with epilepsy (60-70%).
• Surgery.  When electrical activity due to seizures come from a single particular area of brain (focal seizures), brain surgery may be done to remove that area to stop future seizures. Epilepsy surgery is commonly done if the seizure focus is located in the temporal lobe of the brain and the person is not responding to 2 or more seizure medication

4. Other treatments. When seizure medication fails and epilepsy surgery is not possible or not feasible, treatments modalities such as vagus nerve stimulation or ketogenic diet can be considered

Yes, seizures can occur in children of all ages, from infancy through adolescence. Pediatric seizures can be caused by various factors, including fever (febrile seizures), epilepsy, genetic predisposition, infections, head injuries, metabolic disorders, and neurological conditions. Seizures in children may manifest differently than in adults, and they can present as convulsions, staring spells, sudden changes in behavior, or loss of consciousness. It’s essential for parents and caregivers to recognize the signs of seizures in children and seek medical attention promptly.

Yes, seizures can occur in a 10-year-old child who is very intelligent. Epilepsy, the condition characterized by recurrent seizures, can affect individuals of all ages, backgrounds, and levels of intelligence. Intelligence does not serve as a barrier to developing epilepsy or experiencing seizures. Seizures can be triggered by various factors, including genetic predisposition, brain injury, infections, or other neurological conditions. Even children who excel academically and show high intelligence may still be susceptible to seizures. It’s important for parents and caregivers to be aware of the signs and symptoms of seizures, regardless of the child’s intelligence level, and to seek medical evaluation and appropriate treatment if seizures occur. With proper management and support, children with epilepsy can continue to thrive and reach their full potential.

The common seizure medications include phenytoin, valproate, phenobarbitone, levetiracetam, brivacetam, carbamazepine and oxcarbamazepine

Add on medications for seizures include clobazam, topiramate, zonisamide, perempanel, lamotrigine, ethosuximide, lacosamide

In special situations, steroids, vigabatrin, nitrazepam and clonazepam are also used

There is nothing like best seizure medicine. The choice of seizure medicine is dependent on age of patient, work profile, type of seizures, type of epilepsy and cause of epilepsy

The success rate or effectiveness of seizure medication is roughly 60-70%. Meaning that out of 100 patients with epilepsy, 60-70% will not have seizure recurrence, and 30-40% might still have recurrence on seizure medication

No medicines are 100% effective. The goal of seizure treatment is to prevent serious seizures, reduce the seizure duration, reduce the frequency of seizures and minimise emergency visits to hospital. So yes, do not stop seizure medication, even if there are seizure recurrences in spite of medications.

During any illness like cough cold and loose stools, do not stop the seizure medication, else there would be seizure recurrence. Some antibiotics can cause drug interaction with seizure medication. So, please discuss with your local physician about the medicines. Do not take over the counter medication especially antibiotics. The risk of seizure recurrence is maximum during fever, and Viral illness.

The epilepsy medicines are safe. No seizure medications have no side effects. All medications have low risk of side-effects, but they are not severe or not life threatening. Pls discuss the side effects with the doctor. Your neurologist doctor will explain you the specific follow up for each medication

Epilepsy medicines might cause sedation or excessive sleepiness. But this is transient, and reduces with time. Reduced intelligence is uncommon, but can be due to effects of recurrent seizure. The question you should ask yourself is that what is dangerous: seizures or side effect of medicines. What is it that you want to prevent: seizures or side effect of medicines? Every treatment has some effects. That doesn’t mean that you do not take the treatment. The only thing is that you must understand the side effect of seizure treatment

In general, for a person with single episode of seizure, seizure medications are not started if both EEG and MRI brain is normal

If either of them is abnormal or the first seizure is prolonged duration (> 5 min), its recommended to start seizure medicines

The simple answer is yes. But if gap between 2 seizures is more than 2 years, you may wait. In such a condition, you have to understand the risk involved. Seizures are usually not dangerous or life threatening. But injuries during seizures can be life threatening. The goal of seizure treatment is to prevent serious seizures, reduce the seizure duration, reduce the frequency of seizures and minimise emergency visits to hospital. Prolong seizures > 5min and multiple seizure in one day, usually necessitates hospital admission for few days. Regular seizure medication may reduce this risk. If you do not start seizure medication, you will always live-in worry about seizure recurrence and will affect work quality and performance

Roughly, seizure medication is given for 2-3 years from the time of last seizures. However, the duration of treatment is different for different types of epilepsy. Certain epilepsy like juvenile myoclonic epilepsy needs lifelong treatment. Almost 80% of benign Childhood onset epilepsies will stop having seizures by 12-14 years of age

First epilepsy treatment is not a course like antibiotics. The epilepsy medicines are medicines for control of seizures and they actually do not cure the epilepsy. Epilepsy gets cured when the electrical focus of seizures in brain stops firing excessive abnormal currents. It is expected that the seizure focus will improve in 2-3 years

The cure rate of epilepsy is dependent on type of epilepsy and cause of epilepsy. Hypocalcaemia seizures are 100% treatable. Fever with seizure may not recur and are cured in 2-4 years. Seizures with neurocysticercosis have a very variable course. Absence epilepsy treatment is roughly till 10-14 years of age.

There is recurrence rate of 10-15% of seizure if seizure medicines are stopped. The recurrence risk is dependent on number of seizure medicines, number of seizures, degree of EEG abnormality at diagnosis, MRI abnormality, degree of EEG abnormality at stopping medicines, family history of epilepsy.

The recurrence risk is maximum in first 6 months, but the seizures can recur can recur later as well. Patients will abnormal MRI have life-long risk of seizures. The recurrence risk is dependent on type of epilepsy.

I developed seizure recurrence after stopping medicines, how long is the further course?

If you develop seizure recurrence after stopping medicines, it means the seizure focus is still active. You will have to take the seizure medicines

If you develop a seizure on missing dose, it means that the seizure focus in your brain is active and you need to continue seizure medications. The duration of treatment, is minimum 2-3 years from the last seizure

When seizures recur after completing three years of treatment and medication is discontinued, the duration for which anti-seizure medications need to be resumed varies depending on individual circumstances. It is essential to consult a neurologist or epilepsy specialist to determine the appropriate course of action. Factors such as the type of seizures, frequency, severity, underlying causes, response to previous treatment, and overall health will be considered in making this decision. In some cases, medications may need to be resumed indefinitely to maintain seizure control and prevent further episodes. Close monitoring and periodic evaluations by healthcare professionals are crucial to adjust treatment plans as needed and optimize outcomes for individuals living with epilepsy.

While two years seizure-free may be a starting point for considering medication withdrawal, it’s crucial to remember that stopping any medication, including ASMs, should never be done without consulting your neurologist. They can assess your individual situation and determine if discontinuing medication is a possibility.

Several factors contribute to this decision, including:

• Type of epilepsy: Some types carry a higher risk of seizure recurrence than others.
• Number of medications used for control: Individuals who required multiple medications to achieve seizure freedom may have a higher risk of relapse after stopping.
• EEG results: Electroencephalogram (EEG) tests can reveal abnormal brain activity even in seizure-free individuals, indicating a potential risk of future seizures.
• Other medical conditions and risk factors: Underlying health conditions, family history of epilepsy, and specific seizure triggers can also influence the decision.

The primary risk involves the possibility of seizure recurrence. This risk varies depending on individual factors but can be significant, with approximately 30-50% of individuals experiencing seizures after stopping medications.

Stopping ASMs abruptly can be dangerous and lead to withdrawal seizures. Always follow your doctor’s tapering plan, which involves gradually decreasing the medication dosage over a specific timeframe. This minimizes withdrawal symptoms and allows the body to adjust.

What are the potential withdrawal symptoms when stopping ASMs?

These symptoms may vary depending on the specific medication and individual factors but can include:

• Increased anxiety or irritability
• Difficulty sleeping
• Headache
• Nausea or vomiting
• Tremor

 What should I do if I experience symptoms after stopping ASMs?

It’s crucial to immediately contact your healthcare provider if you experience any concerning symptoms after stopping your medication. They can assess the situation and adjust the tapering plan or reinstate the medication if necessary.

It’s important to emphasize that individuals should never make decisions about stopping anti-seizure medication (ASMs) based solely on online information and that consulting a healthcare professional is crucial. However, here are some factors that might suggest a potentially higher risk of seizure recurrence after starting ASMs:

1. Short seizure-free period: While two years seizure-free is often considered a starting point for considering medication withdrawal, a longer period of seizure freedom (typically 3-5 years) generally indicates a lower risk of recurrence.

2. Underlying cause of epilepsy: Certain factors associated with epilepsy can increase the risk of recurrence, even after starting ASMs. These include:

• Structural abnormalities in the brain: The presence of lesions, tumors, or other abnormalities detected through imaging studies like MRI scans can elevate the risk.
• Specific epilepsy syndromes: Some types of epilepsy, like certain genetic generalized epilepsies or those with a strong genetic component, might carry a higher inherent risk of recurrence.
• History of febrile seizures: Individuals with a history of seizures triggered by fever in childhood can have a higher risk of developing epilepsy later in life and experiencing future seizures even with medication.

3. Type and severity of seizures:

• Multiple seizure types: Individuals with multiple types of seizures, like both focal and generalized seizures, may have a higher risk of recurrence compared to those with only one type.
• Drug-resistant epilepsy: If seizures persist despite trying various ASMs at appropriate dosages, it suggests a more complex form of epilepsy and potentially a higher risk of recurrence after stopping medication.

4. Abnormal EEG findings: Electroencephalogram (EEG) tests measure brain activity and can sometimes detect abnormal patterns even in individuals who haven’t experienced recent seizures. These abnormal findings could indicate a higher risk of future seizures, even with medication.

5. Additional medical conditions: Certain pre-existing medical conditions, such as brain tumors, infections, or head injuries, can increase the risk of seizure recurrence, regardless of medication use.

6. Other risk factors:

• Age of onset: Individuals diagnosed with epilepsy at a younger age, especially in childhood, often have a higher risk of recurrence compared to those with adult-onset epilepsy.
• Family history of epilepsy: Having close family members with epilepsy can increase your own risk.
• Lifestyle factors: Poorly controlled sleep and certain substances like alcohol or drugs can increase the risk of breakthrough seizures despite medication.

It’s important to remember that these factors provide a general overview and don’t guarantee the likelihood of seizure recurrence. Every individual’s situation is unique, and a healthcare professional can comprehensively assess these factors and your specific circumstances to determine the appropriateness of stopping ASMs or adjusting your treatment plan.

Several factors can indicate a higher risk of seizure recurrence after stopping anti-seizure medication (ASM):

Individual Medical History:

• Age of seizure onset: Individuals who experience the first seizure at a younger age, especially under 12, may have a higher risk of recurrence after stopping medication.
• Seizure frequency and severity: A history of frequent or severe seizures before achieving seizure freedom can increase the chance of returning after stopping medication.
• Type of epilepsy: Certain types of epilepsy inherently carry a higher risk of recurrence compared to others. These include generalized epilepsies like absence seizures or myoclonic seizures, and certain types of partial onset seizures.
• Duration of seizure freedom: A longer period of seizure-free status while on medication generally translates to a lower risk of recurrence after stopping. Two years is a common starting point for considering medication withdrawal, but it’s not a definitive threshold.

Treatment factors:

• Number of medications used: Individuals who required multiple ASMs to achieve seizure control may have a higher risk of experiencing seizures after stopping them.
• Tapering process: Abruptly stopping ASMs is highly discouraged and significantly increases the risk of seizures. A slow and gradual tapering process under medical supervision is crucial.

Other factors:

• Underlying medical conditions: Certain medical conditions like brain tumors or infections can contribute to seizure occurrence and influence the risk of recurrence after stopping medication.
• Family history of epilepsy: Having a close family member with epilepsy can increase the individual’s risk.
• Abnormal EEG findings: While not definitive, abnormal brain activity patterns observed on an electroencephalogram (EEG) even during seizure-free periods can suggest a higher chance of recurrence after medication withdrawal.

It’s important to understand that these factors are not absolute and serve as indicators, not guarantees. The decision to stop ASMs should be made in consultation with a qualified healthcare professional who will consider all individual factors and risks to make the best recommendation for your specific situation.

One must know that epilepsy medicines are not addicting. If you develop a seizure on stopping medicines, it means that the seizure electrical focus in brain is still active. Seizure medication should not be stopped abruptly, but tapered as per supervision of neurologist. In certain types of epilepsies, treatment may be lifelong

Many kinds of doctors treat patients with epilepsy. These doctors include general physicians, paediatricians, neurologist, epileptologist. Seizures are also managed by neurosurgeons due to surgical causes. These doctors may start initial treatment and may discuss with a neurologist.

A neurologist is a doctor who specializes in the brain disorders, spine and nerves. An epileptologist is a neurologist who specializes in epilepsy. When seizures recur or treatment fails, it is best to take treatment by a neurologist or epileptologists for best and expert epilepsy treatment.

Patients with difficult to control seizures or poorly controlled epilepsy or seizures inspire of multiple seizure medications may be referred to an epilepsy centre. Epilepsy centres are available in Delhi, Pune, Mumbai, Chennai, Bangalore, Trivandrum, Kochi. The centres are managed by staff who specialize in epilepsy care, such as

• Epileptologists and neurologists.
• Epilepsy Nurses.
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• EEG Technicians.
• Neurosurgeons
• Epilepsy Radiologist
• Nuclear Physicians

There are several ways you can find a neurologist or an epileptologist near you. Your general physician can guide you about types of specialists.

Self-management is what you do (or your nearby friends and relatives) to take care of yourself during emergency. You (nearby friends and relatives) should know how to manage seizures. Begin with these simple tips:

• Take your medicine.
• Talk with your doctor or nurse when you have questions.
• Recognize seizure triggers (such as flashing or bright lights).
• Keep a record of your seizures.
• Keep a record of medicines you are taking along with doses
• Get enough sleep.
• Lower stress.

To prevent seizures, you may be able to figure out the trigger that caused seizure recurrence. Identification of trigger is the easiest treatment of epilepsy. To know more, read here