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Epilepsy Treatment

Generally, epilepsy is successfully treated with antiepileptic medications. 60%-70% of people diagnosed with epilepsy will gain seizure control with medication. Others may continue to have seizures, but less frequently.

When seizures continue to recur even with medication other treatment options such as surgery, stimulation of the vagus nerve, or, especially in children, the ketogenic diet may be considered. In the hope of seizure control complementary therapies are often explored. Any consideration given to complementary therapies should be thoroughly researched and discussed with your treating doctor.

Antiepileptic medications

Side effects & interactions

Managing your medications

Generic medications & substitution

Caution – Online pharmacies

Surgery

Vagus Nerve Stimulation Therapy

Ketogenic Diet

Complimentary therapies

Antiepileptic medications

Treatment is usually with antiepileptic drugs also referred to as AEDs. Many epilepsy syndromes respond well to a specific drug or to a combination of drugs. Drugs do not cure epilepsy but most seizures can be prevented by taking medication regularly one or more times a day.
Optimally, the doctor and the patient will jointly make the decision about medication. Factors taken into consideration include:

  • Type of seizure
  • Likely risk of having other seizures
  • Age of the person
  • Gender of the person
  • Persons general health
  • Opinion of the person

Of people at risk of recurring seizures, more than 60% are likely to achieve complete seizure control with medication within a year.

Medications prescribed for epilepsy in Australia

Adrenocorticotropic Hormone ACTH
Carbamazepine Tegretol, Teril
Clobazam Frisium
Clonazepam Rivotril, Paxam
Ethosuximide Zarontin
Gabapentin Neurontin, DBL Gabapentin, Douglas Gabapentin, Gantin, Gabahexal GenRx Gabapentin, Nupentin, Pendine
Lacosamide Vimpat
Lamotrigine Keppra
Oxcarbazepine Trileptal
Phenobarbitone  
Phenytoin Dilantin
Primidone Mysoline
Sodium Valproate Epilim, Valpro
Sulthiame Ospolot
Tiagabine Gabitril
Topiramate Topamax
Vigabatrin Sabril

Commencing medication does not always mean that it must be taken for life. Regular medical reviews are recommended and many people need medication for a limited time, usually a few years.

Do not suddenly stop taking medication as this can provoke seizures and possibly a medical emergency. Withdrawing from medication should always be carried out under medical supervision. Any changes to dose should be guided by the treating doctor.

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Side effects & interactions

Seizure medication can interact with other medications including the contraceptive pill and some common over-the-counter treatments. It's important for people to check for this when a doctor, pharmacist or other medical practitioner, suggests new medications.

Any side effects that are thought to be a result of the medication should be discussed with your doctor or epilepsy counselor. Sometimes the medication can be carefully switched to avoid unwanted side effects.

For many people, medication makes it possible to live normal, active lives free of seizures. Others may continue to have seizures, but less frequently.

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Managing your medication

Some people are particularly sensitive to increased seizures when they miss a dose of their antiepileptic medication. The longer the break between doses, the lower your blood levels will go and the greater your chance of having a seizure. If you take your medication erratically or you suddenly stop taking all medication, you may trigger a severe and prolonged seizure or a cluster of seizures that will require hospitalisation.

Remembering to take medication regularly can be a problem. Many people with epilepsy experience difficulty with their short-term memory. Using a dosette box can help. It may also be helpful to carry a daily dose of your medication with you in case you are not at home in time to take the next dose.

The traditional advice on missing a dose has often been to simply pass on it and not to try to catch up. That is not always a good idea.  The current view is that you should take the missed dose as soon as you realise it was missed, even if this isn't until the next dose is due. That is, you should catch up. The risk of this is minor overdose, the symptoms of which are not serious and will last no more than a couple of hours, while the risk of not doing so is a seizure. Make sure you discuss this with your doctor.

Better yet, make sure you don't miss a dose. Some of the things you can do to remind yourself to take your medication is:

  • to make it part of your daily routine take it with meals or take it when you get up and when you go to bed.
  • keep your tablets on top of your pillow or in the kitchen.
  • use a digital watch alarm to remind you when your medication is due

It is more important to take your medication at a time when you are more likely to remember than at exactly 12 hourly [or 8 hourly] intervals.

Important information about AEDs:

  • Seizure medication may be started slowly with the dose gradually increasing
  • The treating doctor should guide changes to the type or dose of medication
  • A new medication is often introduced while the old medication is reduced
  • Sometimes a combination of medications is used
  • Try not to miss a dose. Ask your doctor what to do if this happens
  • A dosette box can help people to remember their medication
  • If you are still having seizure while taking medication tell your doctor
  • Plan ahead so you do not to run out of your medication
  • Illness, diarrhoea and vomiting may affect the absorption of medication
  • Seizure medication should not be stopped suddenly.

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Generic medications & substitution

A generic drug is a drug based on a branded product but made by a different manufacturer. Research suggests that the minute difference between two versions of the same drug may cause problems for people with epilepsy if they are switched from one to another. While the chemicals used are exactly the same, there can be slight variations between the drugs due to the manufacturing process. For the vast majority of drugs this has little or no impact on the person taking the medication. However due to the way antiepileptic drugs work even the slightest variation in the amount of the drug taken appears to cause problems for some people with epilepsy.

Many generic formulations of some antiepileptic medications are now available In Australia and it is now government policy for pharmacists to ask if a cheaper brand would be preferred.

It appears that any switch in medication whether it be branded to generic, generic to branded, or generic to generic may cause an increase in drug side effects, an increase in seizure frequency or breakthrough seizures in people whose seizures were previously well controlled.

People with epilepsy are advised to continue taking their prescribed medication. When a prescription is filled, check that the tablets are the same size, shape and colour, and the packaging carries the same name as prescribed by your doctor. If your pharmacist suggests that switching to another product can save you money politely refuse and insist on your usual medication. Switching drugs is not worth the risk.

In an article for The Epilepsy Report, internationally respected neuropharmacologist, Professor Frank Vajda addresses the controversial issue of generic substitution and epilepsy.

Generic substitution in epilepsy: a controversial issue.  The Epilepsy Report, Issue 2, 2006.

Generic medication consumer update The Epilepsy Report, Issue 1, 2009.

Epilepsy Australia continues to lobby the Federal government for antiepileptic medications to be excluded from those PBS medications flagged for substitution.

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Caution - Online pharmacies

There has been an influx of online pharmacies offering discounted products by mail order. While this may be perfectly safe for ordering vitamins and other over-the-counter products, caution should be taken if considering ordering prescription medication this way. As it is Australian Government policy to allow pharmacists to offer generic substitutions, you may have no control over the possible substitution of your prescribed medication and the inherent risks such substitution can have on your level of seizure control.

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Surgery

Epilepsy is sometimes caused by an area of abnormal brain tissue. There are many reasons why an abnormality occurs and it may be unimportant unless it causes seizures. The size and position of the area, referred to as the epilepsy focus, varies between individuals. If surgery can remove the epilepsy focus, seizures can often be prevented. The chance of successful surgery and the risks of complications differ for each patient.

Surgery is usually only used where medication fails and is not intended to be a substitute for medication. If surgery is considered to be a possible treatment for your epilepsy, several months of extensive testing and counseling are undertaken before surgery is performed. Your doctors will then discuss with you, the possible outcomes from surgery in your case, so that you can make an informed choice. Your Epilepsy Australia Member can provide you with specialised literature on this topic.

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Vagus Nerve Stimulation Therapy

Vagus Nerve Stimulation Therapy [VNS Therapy] uses a small medical device (the pulse generator) that sends small electrical pulses to the left vagus nerve in the neck. The vagus nerve has many connections to areas in the brain instrumental in producing seizures and by stimulating the vagus nerve the brains potential to generate or spread abnormal seizure activity can be reduced.

Implanting a vagus nerve stimulator is generally only considered if antiepileptic drugs are not controlling the seizures satisfactorily and other surgical options have been ruled out. The operation to implant a vagus nerve stimulator takes approximately two hours with the device implanted under the skin just below the left collar bone or close to the armpit. A second small incision is made in the neck to attach two tiny wires to the left of the vagus nerve. The wires are threaded invisibly beneath the skin from the pulse generator to the vagus nerve in the neck. Over the following two days, the device is programmed to automatically deliver stimulation on a regular, frequent basis, usually every 300 seconds, around the clock.

Not all types of epilepsy will respond to this treatment. While results are mixed, there seems to be a significant number of people with this device whose seizure frequency has reduced radically or whose seizures have stopped altogether. Your neurologist can determine if this treatment is an option for you.

In relation to any surgery, while the best possible outcome is anticipated for each patient no surgical procedure is risk-free. Successful surgery however can prevent seizures from occurring, or dramatically reduce seizure frequency and thereby change a person's life forever.

For further information on VNS Therapy visit 
www.vnstherapy.com

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Ketogenic Diet

The Ketogenic diet is a strict, medically supervised diet that may be a treatment option for some children with epilepsy. It involves a restricted fluid, high fat and very low carbohydrate and protein diet that ensures the body will burn fat rather than carbohydrate and protein for energy, thus producing ketones. In some ways, the diet mimics the body's metabolic state during fasting or illness. This high ketone state (ketosis) decreases seizure activity in some circumstances by mechanisms, which are not fully understood. The diet deliberately maintains this build up of ketones by a strictly calculated, individual regimen with rigid meal plans.

The ketogenic diet is not a "natural therapy". Less is known about the beneficial and adverse effects of the ketogenic diet than other treatments for epilepsy eg. antiepileptic medications, surgery. The ketogenic diet has not been subjected to the usual clinical trials that establish efficacy and safety of a treatment for a medical condition.

The ketogenic diet is generally only suitable for children with poorly controlled seizures. Assessment by a paediatric neurologist experienced in epilepsy management and monitoring of the diet and drug therapy is a prerequisite. Generally, young children with mixed myoclonic seizure disorders are thought to respond best to the ketogenic diet. Some centres have reported success with adult patients and patients with other epilepsies.

For more information about the Ketogenic Diet click here

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Complementary therapies

Complementary therapies may assist a person with epilepsy by improving overall health and wellbeing. However, research does not suggest that complementary therapies are likely to improve seizure control in most cases. In some situations they have been shown to trigger seizures.

If you believe that using a complementary therapy in conjunction may be of benefit, discuss this with your doctor. It is recommended that you do not stop you antiepileptic medication unless advised to do so by your doctor.

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