Uncontrolled Seizures - Treatment & Services
The mainstay of seizure treatment is the appropriate use of antiepileptic medication. Proper drug treatment, in combination with patient support and education, can result in effective seizure control for 70% to 80% of people with epilepsy.
Medication, however, may prove ineffective for the control of seizures in a small but significant number of patients. The most common causes of treatment failure include:
- Use of a sub-optimal medication for a particular seizure type
- Inability to properly determine by standard examination and testing methods the type of seizure experienced
- Occurrence of certain neurologic or psychological symptoms that can mimic seizures
- Failure to take medication as prescribed
Proper Use of Antiepileptic Medications
An individual may not obtain immediate seizure control after starting antiepileptic drug treatment. It may be necessary to adjust the medication dosage upward before it is known whether or not a drug will be effective. Increased dosage may cause side effects from a high blood level of the medication. Such dose-related side effects are temporary, and resolve with reduction in the amount of medication taken.
It is important to report to your doctor any symptoms you feel may be related to medication side effects. Do not adjust the dosage without first discussing it.
When Should a Medication Be Considered to Have Failed?
If you are taking a dosage of antiepileptic drug just below the amount that produces side effects, and you continue to experience seizures, then that drug may be ineffective.
Your doctor may want to make certain that there are not additional factors resulting in poor seizure control. These may include another medication that interferes with the action of the antiepileptic drug, or certain lifestyle aspects such as insufficient sleep.
At that point, another medication may be added. The second drug may require upward adjustments as well.
There is no single answer as to when alternative treatments for epilepsy should be considered. This determination varies from individual to individual. It is important to know that all reasonable attempts at treatment with standard antiepileptic drugs have been made before considering the options below. Evaluation at a specialized epilepsy center may allow some of these questions to be answered.
Treatment for Refractory Epilepsy at Temple University Hospital
Seizures unresponsive to medication are considered "refractory" or "intractable." Treatment options include the following:
- Epilepsy surgery:
Surgery is an accepted, often effective, treatment for seizures that are refractory to medical therapy. The evaluation to determine whether who is a candidate for this treatment is undertaken in a careful, stepwise fashion and requires commitment on the part of both the patient and doctor. Surgical treatment can be considered if:
- Seizures start in one part of the brain ("focal" in onset)
- The area can be identified by testing
- The seizure focus in the brain can be removed without producing a medical or neurologic complication
- Investigational drugs:
Prior to widespread use, new antiepileptic drugs are tested for effectiveness in patients with difficult-to-control seizures. By the time these medications are being tested in patients with epilepsy, they will have been evaluated for safety in large numbers of volunteers.
Your doctor can tell you the potential benefits and potential problems that may be encountered in an investigational study. Often, treatment for seizures is provided free of charge for participation -- and there is the possibility of improved control of your epilepsy. Your doctor or the Epilepsy Foundation can assist you with locating medical institutions where investigational drugs are being tested.
- Vagus nerve stimulation:
At a small number of epilepsy centers, a procedure called vagus nerve stimulation is being tested. This involves the implantation of a device much like a cardiac pacemaker. It delivers intermittent, low-level electrical pulses to the vagus nerve in the neck. By a mechanism that is not completely understood, these impulses may travel to the brain centers controlling seizure production, in particular the temporal lobe and its connections.
If you have questions about these treatments, contact your physician, the local or national chapters of the Epilepsy Foundation and specialized epilepsy treatment centers.
To learn more about treating your uncontrolled seizures, please call Temple's Department of Neurology at 215-707-3040.