Epilepsy is a lifelong and debilitating disease which is characterized by uncontrollable, recurrent and spontaneous seizures. It is a disease with potential complex consequences (economic, social, psychological) that affect both the patient and its family. Epilepsy is a chronic cerebral disorder characterized by recurrent and spontaneous seizures that are typically unprovoked and unpredicteble. An epilepsy seizure represents a transient episode of supratentorial origin, characterized by an abrupt and temporary alteration of cerebral function, due to an abnormal paroxysmal discharge of cerebral neurons caused by cortical hyperexcitability.
Being a chronic cerebral disorder, its treatment should avoid the causes that may trigger a seizure. This approach include general lifestyle measures including diet, hypoglycemia avoidance and a balanced physical activity. Patient should also avoid sleep deprivation, alcohol intake, drugs or caffeine intake. Potential dangerous activities that may generate accidents during a seizure, such as working at altitude, near thermal sources should also be avoided.
Each country has specific legal regulations that include rights and limitations for an epileptic patient regarding professional activity choices, car driving, cost free medication and others.
Epilepsy Seizures Medical Treatment
Epilepsy medical treatment is continuous and consist of drugs which should be chosen according to the type and frequency of crisis. Treatment must be administrated at least 2-3 years after the last seizure and after this period, according to the individual context, the dose can be gradually reduced. In cases where initial therapy correctly chosen is not efficient, an second anticonvulsant drug should be added.
Antiepileptic drugs poses multiple action mechanisms that include blocking the activation of sodium channels, enhancing GABA (gamma aminobutyric acid) receptors, glutamate modulators, calcium channels blockers, carbonic anhydrase inhibitors, neuronal potassium channel openers. In practice, most used antiepileptic drugs are:
Valproic acid and its salts poses an inhibitory action on voltage dependent sodium channels and an enhancing activity on GABA receptors. Major indication is represented by idiopathic generalized epilepsy, but is effective in partial epilepsy seizures too. Adverse effects are represented by gaining weight and it was proven that poses teratogenic effects (capability of producing fetal malformation).
Carbamazepine has a modulator effect on voltage dependent sodium channels and is indicated in partial epilepsy seizures which may become generalized. Is not indicated in idiopathic generalized epilepsy because may worsen the absence epilepsy crisis and myoclonus.
Oxacarbazepine is a carbamazepine analouge which acts by inhibiting sodium channels and by modulating potassium channels. This drugs has the same indication as carbamazepine, but with considerably less side effects.
Fenitoin is indicated both in generalized and focal epilepsy seizures and presents important side effects such as gum hypertrophy, cardiac rhythm disturbances, cerebellar toxicity and facial hair growth. Injectable form is used in status epilepticus treatment.
Phenobarbital is useful in all forms of epilepsy, except typical absence seizures. Currently is more useful as an emergency therapy and side effects are represented by sedation and cognitive impairments.
Ethosuximide acts by reducing the calcium influx in thalamic neurons and is indicated exclusively in absence epilepsy seizures.
Lamotrigene is indicated all type of epilepsy seizures and presents minimal impact on cognitive functions and minimal teratogenic effect, therefor is indicated in pregnant women.
Epilepsy Seizures Surgical Treatment
Surgical procedures are reserved for cases with refractory epilepsy seizures to any drug combination correctly chosen and in maximal dose and for repeated seizures that influence patient’s life quality.
Brain surgery procedure for epilepsy are palliative and potential curative and are represented by:
- Anterior callosotomy, represented until few years ago the most common palliative procedure in patients with intractable atonic seizures with facial and neck injures due to a fall. This procedure was replaced by vagal nerve stimulator.
- Lobectomy and lesionectomy (surgical removal of lesions), because 25% of patients present lesions identified by MRI which can cause seizures. This lesions are represented by: low grade astrocytomas, cortical dysplasias, cavernous angiomas, and areas of focal atrophy.
- Temporal-lobe surgeries are reserved for cases with temporal epilepsy.