Help the development of the site, sharing the article with friends!

Treatment of epilepsy is primarily pharmacotherapy. There are many different antiepileptic preparations - the choice of the drug for a specific patient depends, among others, on from his age, the type of seizures he has or other medical conditions he has. In addition to medications, treatment techniques are sometimes also used in the treatment of epilepsy, and even … a specific diet.

Treatment of epilepsyis strictly dependent on which type of epilepsy has been diagnosed in a given patient. Epilepsy is one of the most common neurological diseases - according to the World He alth Organization (WHO), it affects up to 50 million people worldwide.

The sheer number of cases should suggest that epilepsy may be different in different people, and it is indeed so - there are both many different types of epileptic seizures and many different epilepsy syndromes.

The purpose of distinguishing the above-mentioned is primarily to select the appropriate treatment for a given epileptic patient - it turns out that some epileptic seizures can be controlled with one drug, others with the use of a completely different preparation, and in the case of yet different it becomes necessary to use methods of epilepsy treatment other than pharmacotherapy.

Epilepsy - symptoms and help the patient

Pharmacological treatment of epilepsy

Pharmacotherapy is the primary treatment for epilepsy. This is mainly due to the results that can be achieved thanks to drugs - it turns out that thanks to pharmacotherapy it is possible to obtain good epilepsy control in up to 60-80% of patients with this disease.

The group of antiepileptic drugs currently includes many different preparations. It is definitely not the case that a neurologist dealing with an epileptic patient recommends any of the available funds at random - before starting treatment, it is necessary to first determine exactly what type of epileptic seizures occur in the patient.

  • Seizures: types
  • Status epilepticus
  • Psychogenic pseudo-epileptic seizures

This is because different ones are treated withdifferent preparations. Choosing the right drug is also necessary because it happens that some antiepileptic drugs … may even worsen the patient's condition - this is the case with carbamazepine, which should not be administered, for example, to patients with juvenile myoclonic epilepsy.

In addition to the type of seizures experienced by the patient, the treatment planning for epilepsy also takes into account the patient's age, comorbidities and other medications that the patient uses.

In the case of the latter, it is particularly important due to the fact that there may be interactions between antiepileptic drugs and other drugs, such as weakening or enhancing the effect of individual drugs taken. The most common antiepileptic drugs are:

  • carbamazepine
  • phenytoin
  • valproic acid
  • lamotrygina
  • okskarbazepina
  • levetiracetam
  • benzodiazepines (e.g. diazepam, clonazepam)
  • primidon
  • gabapentyna
  • topiramate
  • retygabina
  • wigabatryna
  • pregabalina
  • lacosamide

Pharmacological treatment of epilepsy: principles of therapy

In the treatment of epilepsy, the aim is to ensure that the patient takes the lowest dose of the drug.

It is most beneficial when therapeutic success is achieved with the use of one antiepileptic preparation - the advantage of monotherapy is, among others, reducing the risk of side effects from antiepileptic treatment.

However, if the expected effects of epilepsy treatment with one preparation are not achieved, then the patient is usually offered an additional, subsequent drug.

It often takes time to determine the right dose of antiepileptic drugs - to reduce the risk of side effects, usually treatment is started with low doses and then gradually increased.

In the treatment of epilepsy, it is very important to take your medications regularly and strictly as prescribed by your doctor. Failure to follow the recommendations and lack of regularity may not only lead to worse treatment effects - there are also patients who are diagnosed with drug-resistant epilepsy, while in fact the lack of treatment results results from improper administration of antiepileptic drugs.

Patients taking antiepileptic drugs must also remember that their behavior also affects the results of treatment.

Patients should avoid situations that may increase the risk of a seizureepilepsy, such as insufficient sleep, drinking alcohol, experiencing severe stress or exposure to flashing lights.

It is impossible to give an unequivocal answer to the question of how long pharmacological treatment of epilepsy must be carried out. Some patients require life-long medication, while others may discontinue their medication over time.

However, in order to be able to think about it at all, the patient must not develop epileptic seizures for a long time - it is generally believed that the withdrawal from pharmacotherapy can be considered after 2-3 years without seizures.

It should be emphasized here that the patient cannot stop taking his medications himself - it is possible only with the consent of the neurologist, additionally - in order not to provoke a seizure - the antiepileptic drugs should be discontinued gradually.

Pharmacological treatment of epilepsy and the patient's age

It has already been mentioned that the selection of an anti-epileptic drug depends, among others, on from the age of the patient with epilepsy. This is due to, for example, the differences in metabolism in different age groups - special care should be taken, for example, in the treatment of epilepsy in children and the elderly.

Treating epilepsy can sometimes be a challenge for women who are procreating. Patients using hormonal contraception should definitely tell their neurologist about it - antiepileptic drugs may weaken the effect of preparations that prevent conception.

In such situations it may be necessary to increase the doses of contraceptives or to replace the hormonal contraceptive with another method of contraception (e.g. condoms).

Treatment of epilepsy in pregnant patients and in breast-feeding women is also a problem. It is known that maternal use of antiepileptic drugs increases the risk of birth defects in her baby.

On the other hand, it is believed that a woman suffering from epilepsy should not stop treatment during pregnancy. In fact, preparation for pregnancy should begin well before conception.

This is when it is possible to modify the standard therapy, such as the maximum and at the same time safe reduction of medications used by the expectant mother.

A woman is also recommended to increase - compared to the standard - supplementation of folic acid.

The topic of breastfeeding by women treated with antiepileptic drugs seems controversial - these drugs may find their way intofemale food. Some specialists are of the opinion that it would be safer to give up breastfeeding in this case.

Others indicate that the concentrations of antiepileptic drugs in the diet are much lower than in the mother's blood, moreover, the child - who was exposed to antiepileptic drugs during pregnancy - theoretically could develop withdrawal syndrome in the case of when she suddenly stops being exposed to such drugs.

This aspect, as mentioned, is quite complex and ultimately gynecologists together with neurologists decide on the management of specific patients.

Drug treatment of epilepsy: side effects

In the treatment of epilepsy, it is important not only to successfully control the occurrence of epileptic seizures - it is also important that the treatment is associated with as few side effects as possible.

Each drug can actually lead to some side effects - in the case of antiepileptic drugs, the most common problems of this type are:

  • gastrointestinal complaints
  • headaches
  • nausea
  • sleepiness
  • double vision
  • feeling tired

The severity of the ailments listed above is most often greatest during the initial period of therapy and usually decreases with time, when the body gradually adapts to the medications taken.

Patients using antiepileptic drugs must, however, be under the constant supervision of a neurologist, as there is a risk of other, often serious side effects, such as severe liver dysfunction.

Some antiepileptic drugs have side effects that are typical for them, quite specific.

This is the case, for example, with valproates, which can lead to weight gain and hair loss.

A side effect characteristic of phenytoin is gingival enlargement.

Treatment of epilepsy with surgery

Procedural epilepsy treatmentis not offered to every epilepsy patient - in most patients sufficient effects are obtained through pharmacotherapy.

Procedural epilepsy treatment is used only when the genuinely expected benefits will outweigh all possible risks.

The treatment procedure is used primarily in patients with drug-resistant epilepsy, i.e. those in which the use of even a combination of several drugs does not allow to controlthe occurrence of seizures to a satisfactory degree.

The techniques of epilepsy treatment include both less and more invasive techniques.

The first of these include such procedures as implanting the patient with a vagus nerve stimulator or neurostimulators influencing the electrical activity of the cerebral cortex itself.

In turn, procedures with a much greater invasiveness include such procedures as :

  • calosotomy (involving the intersection of the connections between the hemispheres of the brain)
  • lobectomy (resection of the part of the brain containing the focus that causes epilepsy)
  • hemispherectomy (removal of one hemisphere of the brain)

It should be added that before carrying out any of the procedures listed, patients undergo a thorough qualification, during which, inter alia, whether important brain centers, such as those responsible for speech or movement control, are damaged during the operation.

  • Telemedicine in the treatment of epilepsy

Treatment of epilepsy: dietary treatment

Some scientists point out that the condition of epileptic patients may be influenced by their diet.

The so-called a ketogenic diet consisting in consuming a large amount of fatty substances with a significant reduction in the carbohydrate content in food.

Of particular note, the ketogenic diet may have beneficial effects in children with drug-resistant epilepsy.

Studies assessing the effectiveness of the ketogenic diet in the treatment of epilepsy are still being conducted, however, opponents of this diet are already pointing to the fact that it is really hard to maintain - consumption of even a small amount of carbohydrates may eliminate any possible positive effects of this diet.

There are no clear opinions, so if you are interested in a ketogenic diet, it is best for the patient to consult their neurologist first before making any changes to the diet.

More about epilepsy:

  • Epilepsy syndromes: types
  • Childhood epilepsy with absences (pycnolepsy, Friedman syndrome)
  • Roland's Epilepsy
  • West's Epilepsy Syndrome
  • Northern epilepsy
  • Alcoholic epilepsy

Help the development of the site, sharing the article with friends!

Category:

Neurology