epilepsy newspaper article

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Epilepsy & Seizures Overview

Dr. Alim Akhtar Bhuiyan

Consultant Neurologist and Epilepsy Specialist

Apollo Hospitals ,Dhaka

Overview of Epilepsy & Seizures

Epilepsy is a recurrent seizure disorder caused by abnormal electrical discharges from brain cells, often inthe cerebral cortex. It is not a distinct disease, it is a group of disorders for which recurrent seizures are themain symptom. Different forms of epilepsy are either secondary to a particular brain abnormality orneurological disorder, or are said to be "idiopathic," without any clear cause.

Normally, nerve transmission in the brain occurs in an orderly way, allowing a smooth flow of electrical

activity. A seizure occurs when these neurons generate unco-ordinated electrical discharges that spreadthroughout the brain. This can occur with both normal and abnormal nerve cells.

Epilepsy Incidence

Seizure disorders are a common neurological problem. In the United States alone, it has been estimatedthat more than 4 million people have some form of epilepsy.. The prevalence of epilepsy (defined as thetotal of the population suffering from a disorder at a particular time) has been estimated to be about 5 to 8 inevery 1000 people, The number of patients with Epilepsy is more common in developing countriesincluding Bangladesh .

Epilepsy & Seizure Physiology

Physiology of Seizures

In order to understand the process of electrical transmission within nerve cells, it is important to review thestructure and function of a nerve. A nerve cell can be thought of as a tube, having an inner section, andbounded by a cell wall (membrane). Importantly, the chemical composition of the inside of the cell and theoutside of the cell are very different. Specifically, there is a difference in the concentration of sodium andpotassium salts, with sodium being much higher on the outside, and potassium being much higher on theinside. In a normal resting state, special pumps (called membrane pumps) are continually at work tomaintain each salt in its proper location.

When a nerve is called upon to transmit an electrical signal, a sudden movement of these salts from oneside of the cell's membrane to the other occurs. This movement spreads like a wave from one end of thenerve to the other, until it reaches the end. At this point, the nerve's signal may be transmitted to the nextnerve cell either by a direct extension of this process, or, more commonly, by releasing a special chemical

called a neurotransmitter.

Neurotransmitters generally have one of two special functions. One type is responsible for encouraging cell-to-cell communication and is referred to as an "excitatory" neurotransmitter. The second type is able to slowdown, or even stop cell-to-cell communication and is called an "inhibitory" neurotransmitter. In some cases,overactivity of excitatory neurotransmitters or underactivity of inhibitory neurotransmitters may lead toseizure activity by allowing an uncoordinated flow of electrical activity in the brain.

Interestingly, certain areas of the brain are more likely than others to be the source of a seizure. Theseinclude the motor cortex (responsible for the initiation of body movement) and the temporal lobes


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(including a special deep area called the hippocampus, which is involved in memory). The reason for thislikelihood may be that nerve cells in these areas are particularly sensitive to certain situations that canprovoke abnormal electrical transmission. Examples include sensitivity to decreased oxygen levels,metabolic changes, and infection, any of which may lead to a seizure.

Many types of brain abnormalities can be responsible for producing seizure activity. Abnormal dischargesmay spread to other cells in a local area or to remote areas of the brain, resulting in intermittent disturbance

in the brain's normal functions. Changes in brain biochemistry and communication between brain cellsoccur. These basic neurofunctional abnormalities that lead to epilepsy produce the clinical symptoms thatare seen. In turn, recurrent seizures or prolonged seizures can cause injury to the brain. Seizures that lastlonger than 20 to 30 minutes can damage the brain's neurons.

A seizure is often divided into different parts. The aura is a period or warning prior to a seizure. Patients mayexperience unusual smells, visual symptoms, or feelings. The seizure itself is known as the ictus. Theperiod of time after the seizure is called the postictal state.

Seizures were depicted by prehistoric man in cave paintings. Hippocrates wrote of epilepsy and of itsrelationship to the brain. Epilepsy also is described in the Bible. Writings from 4000 years ago depictepileptics as possessed by demons. Julius Caesar, the great Russian novelist Dostoyevsky, and KingCharles II all are said to have had seizures.

Types of Seizures

Seizure Types

There have been many attempts to categorize seizures, based on both the causes of seizures as well as thedifferent seizure subtypes. A well-recognized classification system is the International Classification ofEpileptic Seizure. This divides seizure types by the location in the brain that they originate from.

The two main categories of seizures includepartialseizures and generalizedseizures

Partial seizures are those that begin in a focal or discreet area of the brain. This type can be furthersubdivided into:

Simple partial: No change in consciousness occurs. Patients may experience weakness,numbness, and unusual smells or tastes. Twitching of the muscles or limbs, turning the head to theside, paralysis, visual changes, or vertigo may occur. When motor symptoms spread slowly fromone part of the body to another, this "epileptic march" has been termedjacksonian epilepsy(firstdescribed by Hughlings Jackson).

Complex partial seizures (temporal lobe): Consciousness is altered during the event. Patientsmay have some symptoms similar to those in simple partial seizures but have some change in theirability to interact with the environment. Patients may exhibit automatisms (automatic repetitivebehavior) such as walking in a circle, sitting and standing, or smacking their lips together. Oftenaccompanying these symptoms are the presence of unusual thoughts, such as the feeling of dejavu (having been someplace before), uncontrollable laughing, fear, visual hallucinations, andexperiencing unusual unpleasant odors. These interesting symptoms are thought to be caused byabnormal discharges in the temporal lobe.

Generalized seizures involve larger areas of the brain, often both hemispheres (sides), from the onset.They are further divided into many subtypes. The more common include:

Tonic-clonic (grand mal): This subtype is what most people associate with seizures. Specificmovements of the arms and legs and/or the face may occur with loss of consciousness. A yell orcry often precedes the loss of consciousness. Prior to this, patients may have an aura (an unusualfeeling that often warns the patient that they are about to have a seizure). The person will abruptlyfall and begin to have jerking movements of their body and head. Drooling, biting of the tongue, and
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incontinence of urine may occur. When the jerking movements stop, the patient may remainunconscious for a period of time. The seizure usually lasts 5 to 20 minutes. They often awakenconfused and may sleep for a period of time. The patients may experience prolonged weaknessafter the event; this is termed Todds paralysis.

Absence (petit mal): Loss of consciousness only occurs, without associated motor symptoms.Usually there is no aura, or warning. The loss of consciousness is brief; the patient may appear tobe involved with the environment and briefly stop what they are doing, stare for 5 to 10 seconds,and then continue their activity. No memory of the event exits. Subtle motor movements mayaccompany the alteration in consciousness.

Myoclonic: Myoclonic seizures are characterized by a brief jerking movement that arises from thecentral nervous system, usually involving both sides of the body. The movement may be verysubtle or very dramatic. There are many different syndromes associated with myoclonic seizures,including juvenile myoclonic epilepsy, West syndrome and Lennox-Gastaut syndrome. Most casesof myoclonic epilepsy occur during the first 5 years of life.

West Syndrome

West syndrome involves a group of symptoms including infantile spasms, retardation of psychomotordevelopment, and a particular abnormality on the electroencephalogram (EEG) known as hypsarrhythmia.Infantile spasms are characterized by a particular posturing of the infant's body, in which the child assumes

a jack-knife, or folded, position. These spasms may occur frequently in the course of the day or may becontinuous. Neurological problems are ultimately found in most of these children.

The hypsarrhythmia pattern seen on the EEG is a grossly disorganized pattern of electrical brain activity. Itis often difficult to control the seizures in this syndrome because they usually respond poorly to mostanticonvulsant medications.

Lennox-Gastaut Syndrome

Lennox-Gastaut syndrome is characterized by the early onset of a common seizure type called minor motorseizures. These seizures include the aforementioned myoclonic seizures, atypical absence seizures, andatonic seizures. Atypical absence seizures may involve staring and brief episodes of unconsciousness. Theymay occur in cycles and are associated with EEG findings different from those seen in typical absenceseizures. Atonic seizures may be associated with sudden loss of muscle tone.

Status Epilepticus

Status epilepticus is prolonged, repetitive seizure activity that lasts more than 20 to 30 minutes, during timewhich the patient is unconscious. Status epilepticus is a medical emergency with a significantly pooroutcome; it can result in death if not treated aggressively. Its causes include improper use of certainmedications, stroke, infection, trauma, cardiac arrest, drug overdose, and brain tumor.

Epilepsy & Seizures Causes

Causes of Epilepsy & Seizures

Epilepsy is not associated with any particular disease. Many abnormalities of the nervous system can resultin seizure activity. Seizures can also occur in the normal nervous system when its metabolic balance isdisturbed. The etiology (cause) of epilepsy may be idiopathic (not clearly known) or related to a particulardisease state. About 35% of all cases of epilepsy have no clearly definable cause.

The following summarizes some of the more common factors leading to seizure activity.


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Genetic factors: It is now accepted that some persons may have a genetic predisposition to thedevelopment of seizures. There is also an increased incidence of epilepsy in relatives of those with a seizuredisorder.

Head injury: Seizures may develop at or around the time of injury or years after (usually not more than twoyears later). They may occur with either an "open" or "closed" head injury.

Stroke/cerebrovascular disorders: Seizures can occur at the time of a stroke or many years later. Theymay occur with strokes that result in lack of blood flow to the brain or with those that involve bleeding into oraround the brain.

Metabolic disturbances: This group of disorders changes levels of various metabolic substances in thebody. These disease states sometimes result in seizures.

Electrolyte disturbances (altered levels of sodium, calcium, or magnesium)

Hypoglycemia (low blood sugar) or hyperglycemia (elevated blood sugar)

Renal failure (kidney disease) with uremia (increased urea in the blood) or changes that occuraround the time of kidney dialysis

Hepatic failure (severe liver disease) and elevation of associated toxins

Hypoxia (lowered oxygen delivery to the brain)

Toxic causes: The presence of certain drugs can cause seizure activity. In addition, abrupt withdrawal ofsome substances can lead to seizure activity. These substances that may induce seizures include thetricyclic antidepressants, lithium, antipsychotic medications, aminophylline, and high doses of penicillin.

Illicit drug use, particularly cocaine, heroine, amphetamines, and PCP, can cause seizures. Alcoholwithdrawal can be associated with seizure activity. These seizures usually occur 12-24 hours after the lastdrink but can occur up until 48 hours or more after binge drinking.

Withdrawal from prescription drugs and agents such as barbiturates and narcotics can result in seizureactivity.

Infections: Infections of the nervous system may result in a lowered seizure threshold. These may includemeningitis (infections of the coverings of the brain and spinal fluid), encephalitis (infection of the brain itself),andHIV(human immunodeficiency virus), and related infections.

Tumors and space-occupying lesions: Brain tumors, both malignant (cancerous) and benign, may beassociated with seizures. The anatomic location of the abnormality influences the likelihood of havingseizures.

Degenerative disorders: There are many neurodegenerative disorders that are accompanied by seizures.These include tuberous sclerosis, neurofibromatosis, Tay-Sachs disease, phenylketonuria (PKU), andSturge-Weber syndrome.

Brain damage in infancy: Cerebral palsy secondary to lack of oxygen, infection, or trauma is associatedwith epilepsy.

Febrile seizures: These are an age-associated form of epilepsy that may present as a single seizure or maybe recurring. They are associated with a high fever in children 3 months to 4 years of age and occur in 3%4% of children.

Epilepsy & Other Seizure Disorders
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Disorders That Mimic Seizure Disorders

True seizure disorders must be differentiated from a variety of problems whose symptoms approximate orclosely resemble those of epilepsy. These include other conditions include cerebrovascular (stroke-related)disorders, migraine, narcolepsy, syncope (fainting), and anxiety and other psychiatric disorders.

Another type of spell well known to physicians is the so-called pseudoseizure, or more properlynonepileptogenic seizure. These spells are not triggered by nerve cell discharges that cause true epilepsy,although the patient may experience muscle twitching and even apparent loss of consciousness. Thesespells have a psychiatric component and often coexist in persons who have true epilepsy. EEG monitoringcan help distinguish disorders that mimic epilepsy from true seizures.

Epilepsy & Seizures Diagnosis

Diagnosis of Epilepsy & Seizures

Patients should be evaluated thoroughly after an initial seizure. It is imperative that the clinician take acomplete and detailed patient history, including details of birth, childhood, family history, and medicationregimen; and a thorough medical history, including any illnesses of the nervous system. In some cases,other conditions (e.g., irregular heartbeat) must be ruled out. A thorough history of drug and alcohol use isequally important.

also is helpful to distinguish seizure subtypes, partial or generalized; time of day of the event, includingwhether the seizure occurred during wakefulness or sleep; and any known triggers, such as a flickering light,severe sleep deprivation, or dehydration.

Thorough general physical and detailed neurological examinations also should be performed.

Diagnostic Testing for Epilepsy

Laboratory data utilized in the diagnostic evaluation of patients with seizure disorders may includeCAT scanimaging,magnetic resonance imaging (MRI), andelectroencephalography (EEG). A complete blood

laboratory panel, including drug-toxic screening, and urinalysis are usually performed.

CAT scan brain imaging is often the first radiological study obtained, especially in the emergency roomsetting. It can indicate pathology such as a brain tumor, stroke, brain hemorrhage, acute or remote trauma,and infection. Limitations include inability to evaluate certain structures in the brain in detail, particularly thetemporal lobes of the brain, often the first sites of seizure activity.

MRI brain imaging is performed for many patients with seizure disorders. It has the ability to visualize ingreat detail much of our brain anatomy. Subtle asymmetries in relevant structures, as well as undetectedmass lesions, small strokes, and evidence of trauma may be uncovered. The use of a contrast agent(injected into the vein) can enhance the ability to show underlying abnormalities.

EEG (also known as "brain wave") provides information about the electrical activity in the brain. Unlike CATor MRI, it does not produce an image of the brain, but supplies information about the function or dysfunctionof parts of the brain. Multiple small electrodes are placed at specific points on the scalp on both sides of thehead to record activity generated mainly by the cerebral cortex. Brain wave activity is usually recorded for30-45 minutes.

Many patients will also be tested while hyperventilating (breathing rapidly and deeply), when flashing lightsare flashing, while sleeping, or when sleep deprived. The brain normally exhibits particular patterns on theEEG during wakefulness, drowsiness, and sleep. The duration and character of normal brain-wave activitycan be used as a baseline for comparison with abnormal waves on an EEG.
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Some of the findings on EEG are specific to particular disorders and subtypes of epilepsy. Activity during aseizure can be identified by a pattern on the graph indicating epilepsy called epileptiform. Correlating thistype of data with clinical symptoms of seizures often helps make an accurate diagnosis. The EEG recordingbetween seizures is often abnormal in patients with epilepsy, and so can be helpful in this setting.

EEG can be combined with video monitoring to record activity both electrically and visually. EEG can also beperformed in a long-term care setting with a portable ambulatory unit, to monitor patients for up to many

days at a time.

Other uses of the EEG include evaluation of altered states of consciousness, brain damage, metabolic-toxicinjury, and suspected brain death.

Epilepsy & Seizures Treatment

Treatment for Epilepsy & Seizures

The medications used to treat patients with epilepsy are called anticonvulsants. Many of these drugs areavailable and each has a different mechanism of action, but all serve to reduce the frequency of epilepticseizures. These medications can be given for long periods of time.

Treatment options are evaluated initially based on seizure subtype, as certain anticonvulsants may beindicated for treating some forms of epilepsy and contraindicated for others. When making decisions abouttreatment with a particular agent, the physician should always take into account the patient's entire medicaland medication histories, age and gender, and side-effect profile. It is important to evaluate the risks andbenefits of treatment for each individual. That said, some general principles apply to treatment.

Monotherapy, treatment with a single agent, is the goal. Seizures can be controlled with one agent inapproximately 75% of patients. Management becomes complicated when patients are given medications incombinations. This also risks increasing the number and frequency of side effects, making it less likely thatpatients will take their medication appropriately.

For medications to work effectively, a relatively constant level of medication must be maintained in the body.

This is accomplished by taking medication regularly as directed, without missing doses. The consequencesof missed doses may be a single seizure, more devastating multiple seizures, or status epilepticus.

Divided doses may be preferable with some medications, ensuring a more constant level of medication inthe bloodstream. Appropriate dosing levels depend on many factors, including the patient's body weight,concomitant medications, and reaction to treatment.

Many neurologists believe brand-name medications are preferable to generic products. Generic medicationsmay be produced by different companies without rigorous standards regarding adequate drug level at aparticular dose. Patients who use these medications may therefore be exposed to fluctuating levels ofmedication. For some people with epilepsy, this can result in loss of seizure control. Brand-nameanticonvulsants, meeting stringent standards, provide more confidence in the dose-blood level relationship.

Any medication can cause an allergic reaction. Dermatological problems, including rashes, are not

uncommon. Life-threatening reactions, such as the Stevens-Johnson syndrome, can occur. It is essentialthat patients report any suspected reactions to their physician.

When medications are to be discontinued, it is almost always recommended that they be slowly tapereddown in dosage strength because abrupt withdrawal can produce seizures.

Kidney and liver function testing should be performed to evaluate the ability of these organs to metabolizethe medication; some drugs will require changing the dosage if function is impaired.
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There is still some controversy over whether to treat a patient who has had only a single seizure.Approximately 75% of seizure sufferers have only one seizure and no reoccurrence. In making treatmentdecisions, it is helpful to look at risk factors that may predict a second seizure. These include lesions of thebrain, an abnormal EEG, or a family history of seizure disorders.

Anticonvulsants can reduce the risk of further seizure activity. People who have had more than one seizureshould probably be treated with anticonvulsants.

Epilepsy & Seizures First-Generation Anticonvulsants

First-Generation Anticonvulsants to Treat Epilepsy

It is convenient to divide some of the existing medications into first-generation anticonvulsantsoldermedicationsand second-generationmore recently developeddrugs. Pharmaceutical research of newdrugs is ongoing, with exciting developments in progress. The following medications are first-generationanticonvulsants commonly prescribed for epilepsy.

Phenytoin (Dilantin) was first used in the late 1930s. It has become one of the more commonly usedagents and often is considered the first-line drug to treat seizures. It is thought to work by suppressingelectrical activity in brain nerve cells. It can be given orally or intravenously (IV), and a newer form of thedrug, fosphenytoin (Cerebryx) can be injected into muscle. The oral form has the benefit of once-a-daydosing.

Phenytoin is a first-line agent for treating partial and generalized tonic-clonic (grand mal) seizures. It is alsoone of the main agents used with patients who present with status epilepticus. Phenytoin drug levels need tobe monitored with laboratory testing. The therapeutic concentration recommended is between 1020mg/L.In addition, liver function testing and a complete blood count (CBC) need to be followed. Phenytoin hasmany interactions with other medications, and its own level can fluctuate when other drugs are taken.

Some of the side effects associated with its use include gingival hyperplasia (overgrowth of the gums),hirsuitism/hypertrichosis (excessive hair growth), imbalance, lethargy, anemia, and, in long-term use,peripheral neuropathy (weakness).

Carbamazepine (Tegretol/Carbatrol) has been in use for over 30 years. It is commonly prescribed forthe treatment of partial and generalized tonic-clonic (grand mal) seizures. The mechanism by which it worksis not well understood. In oral form, it can be taken 2 to 3 t imes a day; a recent development of the drug insustained-release form allows for twice-a-day dosing.

Carbamazepine levels need to be followed with laboratory testing. The recommended therapeutic level isbetween 812mg/L. Liver function tests and CBC also need to be checked routinely. Carbamazepine canaffect the levels of a number of other drugs in the body, and its own level can fluctuate when other agentsare taken.

Recognized side effects include drowsiness, imbalance, nausea, anemia, and neutropenia (low, whiteblood cell count). Carbamazepine is also used to treat trigeminal neuralgia, or tic douloureux, a painful nervedisorder of the face, and other neuropathic pain syndromes.

Phenobarbital is the oldest of this group of anticonvulsants. It can be used to treat both partial andgeneralized seizures. It also is used as part of the protocol after phenytoin use in status epilepticus as wellas in neonatal epilepsy. It is available in oral and intravenous forms.

Levels need to be monitored. The recommended therapeutic level is 1540mg/L. A complete blood analysisalso should be routinely conducted. Phenobarbital can cause changes in the metabolism of other drugsthrough its actions on liver enzymes. Side effects may include drowsiness, cognitive impairment, andirritability.


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Valproate (Depakote) has been in use for more than 20 years. It can be prescribed for a broad spectrumof anticonvulsant needs, including partial seizures, generalized tonic-clonic (grand mal) seizures, absence(petit mal), and myoclonic epilepsy. Its mechanism of action is thought to be related to the effect of a brainsubstance known as GABA (gamma-aminobutyric acid). It is available in oral form and must be taken 2 to 3times per day for adequate dosing.

Drug levels must be monitored, as well as liver function, and blood count. The drug's suggested therapeutic

window is 50100mg/L. Side effects include hepatotoxicity (liver damage), nausea, weight gain, allopecia(hair loss), and tremor.

Epilepsy & Seizures Second-Generation Anticonvulsants

Second-Generation Anticonvulsants to Treat Epilepsy

Topiramate (Topamax) is used with other anticonvulsant drugs in the treatment of partial seizures andgeneralized tonic-clonic seizures in adults and children aged 2 to 16. Although its precise mechanism ofaction is unknown, one theory suggests that its anticonvulsant activity may be due in part to increasingGABA (gamma-aminobutyric acid), a neurotransmitter that inhibits excitation of nerve cells in the brain. It isavailable in oral form, including sprinkles for children, and should be taken twice daily.

Majorside effects include drowsiness, nausea, dizziness, and coordination problems. Children may havedifficulty concentrating and may become agressive. Acute glaucoma and visual abnormality, a potentiallyvery serious complication, has been reported in a small number of patients. If any abnormal visualsymptoms occur, patients should notify their physician immediately. There are few drug interactions betweenTopamax and other medications or other anticonvulsants.

Gabapentin (Neurontin) is indicated for the adjunctive treatment of partial seizures, with or withoutsecondary generalization. Although it is structurally related to the substance GABA (gamma-aminobutyricacid), it does not interact with GABA receptors in the brain, and its mechanism of action is unknown. It isavailable in oral form and should be taken three times daily.

No laboratory monitoring of liver, kidney, or hematologic (blood) function is necessary with Neurontin. Itsmajorside effects are fatigue, dizziness, and imbalance. Neurontin also has been used successfully inpatients with neuropathic pain syndromes.

Lamotrigine (Lamictal) is used for the adjunctive treatment of partial seizures. Its precise mechanism ofaction is unknown. It is presently available in oral form. Lamictal should be taken twice daily. No laboratorymonitoring of Lamictal levels are necessary. Its majorside effect is the appearance of a potentially life-threatening skin rash, particularly for patients who also are taking valproate (Depakote). Any patient takingLamictal who develops a rash should immediately report it to his or her physician. Otherside effects includeheadache, nausea, and dizziness.

Tiagabine (Gabitril) is indicated for adjunctive therapy in adults with partial seizures. Its mechanism ofaction may be related to its effect on the brain substance GABA (gamma-aminobutyric acid). It is available in

oral form and should be given in divided doses two to four times daily. No laboratory monitoring of Gabitrillevels are necessary. Some interaction likely exists when Gabitril is taken with other anticonvulsants, in thatits metabolism may be altered. Side effects include dizziness and somnolence.

Keppra (levetiracetam) Keppra is approved for use in adults as adjunctive therapy for the treatment ofpartial seizure disorders. The side effects can include fatigue, imbalance and behavioral changes, whichoften dissipate after the first month of treatment.


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Trileptal (oxcarbazepine) is indicated for monotherapy (used alone) in adults who have partial seizuresand can be used in children as add-on therapy for partial seizures. The most common side effects includedizziness, sleepiness, nausea, and imbalance, but these do not warrant clinical observation.

Zonegram (Zonisamide) is approved for use in adults as adjunctive therapy for partial seizures. It hashowever, been used fairly extensively in other countries for use in other seizure types including generalizedseizures, myoclonic seizures and absence seizures. Side effects can include dizziness, imbalance and

fatigue. Individuals who are allergic to sulfonamide drugs should not use Zonisamide since it is a derivativeof this class of drug

Epilepsy & Seizures Surgery

Surgery to Treat Epilepsy

Surgical resection of epileptogenic areas of the brain in patients with partial seizures sometimes isconsidered when seizure activity fails to respond to even the most aggressive medical management.Patients considered for these procedures are those with intractable seizures, even when given high levels ofanticonvulsant drugs. Video-EEG monitoring on a long-term basis is used to determine where in the brainthe seizures occur. In some patients, placing electrodes beneath the scalp may help to define epileptogenicareas of the brain. Specialized centers throughout the country have multidisciplinary teams to aid in the

evaluation of potential candidates for these procedures

Epilepsy & Seizures Precautions

Precautions for Patients with Epilepsy & Seizure Disorders

The word epilepsy is used when more than one seizure has occurred, and, if someone has a single seizure,they usually are not said to have epilepsy. Unfortunately, epilepsy connotes something very negative tomany people. The terms epilepsyand seizure disorders are often used interchangeably.

Psychosocial Aspects of Seizure Disorders

Seizure disorders can have a profound effect on many aspects of normal daily living. An individual'sperception of his or her own health or illness may be dramatically changed when they have a seizuredisorder. For some patients, epilepsy carries a stigma that may cause them to alter plans regarding theirfuture educational, employment, or social opportunities. Awareness of these issues is key to developing atreatment and counseling plan for patients and their families. Important issues to address and include wheneducating patients about managing epilepsy are:

what seizures are, and what symptoms may warn of their onset

when to notify a physician about any change in symptoms

details of medication dosing, side effects, and importance of medication compliance (takingmedications exactly as they are directed and not missing doses)

importance of laboratory monitoring tests with some drugs

advice on living a healthy lifestyle and avoiding things that may trigger seizure activity (sleepdeprivation, increased stress, alcohol and drug abuse)

counseling women of childbearing age about epilepsy, medications, and pregnancy

Driving and Seizure Disorders


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Although the laws vary somewhat from state to state, most states have rules regarding when seizurepatients can legally resume driving. Typically, patients must have been seizure-free 6 months to a year.While physicians generally are not required to report patient seizures to their state motor vehicledepartments, patients are expected to comply with the laws in their state.

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