Treatment Options for Newly Diagnosed Epilepsy Patients
Epilepsy can be a pretty scary diagnosis for patients and their families. There are always a lot of questions at that initial appointment. Sometimes, they don’t even have to ask; I can look at their faces and see there are still a lot of question marks.
Most often, patients and their families are concerned about treatment. “Can I have a normal life?” The answer to that is generally yes. “Can my epilepsy be cured?” This question is trickier, and depends on their definition of “cured.” What I can tell them is that there is a very high chance their epilepsy can be controlled. And by controlled, I mean they will have zero seizures, have a reduced risk for injury, be able to drive, and, yes, live a fairly normal life.
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Antiepileptic seizure oral medications (AEDs) are successful in controlling seizures in up to 70% of patients. There are close to 30 different AEDs, and different AEDs are used to treat different seizures. In seven out of 10 patients, one of these medications will work.
If two or more AEDs have failed to control your seizures, and we have confirmed that your seizures are caused by epilepsy and not something else, then brain surgery is a widely accepted second option. In this case, we’ll identify which area of your brain is causing the seizures using MRI (magnetic resonance imaging and find out if it’s safe for us to go in and remove that particular area.
When patients first hear me suggest brain surgery, they look at me like I’m crazy. But epilepsy surgery is probably one of the safest we do in neurology, with a risk of less than 1% for any complication. About 70 to 80% of patients who receive epilepsy surgery remain seizure-free.
Most of the time, AEDs or surgery will be the best option. If medications do not work, and you’re not considered a good candidate for surgery because your seizures are produced throughout the brain instead of one specific area, then responsive nerve stimulation and vagus nerve stimulation may be considered. These treatments are used less frequently, and involve devices that electrically stimulate nerves in the body or the brain itself.
In rare, severe cases of childhood epilepsy, we’ll recommend a ketogenic diet, which is essentially a diet of all fats. This type of diet will introduce more ketones, acids produced when your body begins using fat instead of carbohydrates to burn energy. Ketones have been shown to improve seizures. However, a high-fat diet--especially in older adults--can often be more harmful than helpful.
A Normal Life
Once your seizures are controlled with the treatment option that works best for you, you can expect to live a fairly normal life without fear of seizing while driving, at work or out running errands. Though it varies form state-to-state and across countries, people with epilepsy are usually authorized to drive after being seizure-free for six months. It’s completely reasonable to expect that you and your family can live a full and normal life.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
Imad Najm, MD, is Director of Cleveland
Clinic's Epilepsy Center at the Cleveland Clinic Neurological Institute and has
over 22 years experience in clinical and basic mechanisms of epilepsy. View his Healthgrades profile >