Preventing & Managing Epilepsy

GENERAL EPILEPSY
LIVING WITH EPILEPSY

Can Epilepsy be Prevented?

Epilepsy can be prevented by reducing risks of head injury and stroke, or by developing
new vaccines to prevent seizure-producing illnesses. For example, safety belts and air
bags, motor- cycle helmets, and safety seats for infants in automobiles protect against
epilepsy as a result of auto accidents.

How is Epilepsy Diagnosed?

Epilepsy is diagnosed by a specialist, physician, or nurse practitioner. The healthcare professional will complete a medical history, asking questions about the seizure, such as what happened before, during, and after it.

Aside from asking the initial questions, a thorough neurological examination will also be done.

Series of basic tests will most likely follow after all the above. These tests are non invasive and painless.

Further tests may be required such as the following:

Electroencephalogram (EEG)

An EEG can be used to help diagnose and monitor a number of conditions affecting the brain.

electroencephalogram eeg

Magnetic Resonance Imaging (MRI)

MRI is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

magnetic resonance imaging mri

Pet Position Emission Tomography (PET)

Scans are used to produce detailed three-dimensional images of the inside of the body.

position emission tomography

Single Photon Emission Computed Tomography (SPECT)

A type of nuclear imaging test that shows how blood flows to tissues and organs.

single photon emission computed tomography

How is Epilepsy Diagnosed?

Epilepsy is diagnosed by a specialist, physician, or nurse practitioner. The healthcare professional will complete a medical history, asking questions about the seizure, such as what happened before, during, and after it.

Aside from asking the initial questions, a thorough neurological examination will also be done.

Series of basic tests will most likely follow after all the above. These tests are non invasive and painless.

Further tests may be required such as the following:

Electroencephalogram (EEG)

An EEG can be used to help diagnose and monitor a number of conditions affecting the brain.

electroencephalogram eeg

Magnetic Resonance Imaging (MRI)

MRI is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

magnetic resonance imaging mri

Pet Position Emission Tomography (PET)

Scans are used to produce detailed three-dimensional images of the inside of the body.

position emission tomography

Single Photon Emission Computed Tomography (SPECT)

A type of nuclear imaging test that shows how blood flows to tissues and organs.

single photon emission computed tomography

How is Epilepsy Treated?

Medication for Epilepsy

Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy do not have seizures. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures.

Deciding on which medicine to prescribe depends on such things as:
  • Your type of epilepsy
  • Your age

  • Possible side effects

  • Other medicines that you may take for other conditions

  • Whether you are pregnant or planning a pregnancy

A low dose is usually started. The aim is to control seizures at the lowest dose possible. If you have further seizures, the dose is usually increased. There is a maximum dose allowed for each medicine.

Surgery

When seizures come from a single area of the brain (focal seizures), surgery to remove that area may stop future seizures or make them easier to control with medicine. Epilepsy surgery is mostly used when the seizure focus is located in the temporal lobe of the brain.

SUBPIAL TRANSECTIONS

Multiple subpial transection (MST) is a surgical technique in which the connections of the epileptic focus are partially cut without resecting it. Palliative surgery for seizure reduction, generally patients does not become seizure free.

CORPUS CALLOSOTOMY

This is an operation that severs (cuts) the corpus callosum, interrupting the spread of seizures from hemisphere to hemisphere.

Seizures generally do not completely stop after this procedure. Seizures usually become less severe, as they cannot spread to the opposite side of the brain.

HEMISPHERECTOMY

The surgeon removes all or portions of the affected hemisphere. The surgeon also gently separates the hemispheres to access and out the corpus-callostum.

RESPECTIVE SURGERY
Temporal Lobotomy
  • Removal of a portion of the temporal lobe of the brain
  • It is the most common type of epilepsy surgery
  • After surgery, 60% to 70% of patients are seizure free

Frontal Lobotomy
  • Removal of a portion of the frontal lobe
  • It is the second most common type of epilepsy surgery
  • After temporal lobotomy 30% to 50% of patients are free of seizures that impair consciousness or cause abnormal movements
VAGUS NERVE STIMULATION

The goal of VNS Therapy is to prevent seizures before they start, and stop them if they do.

Benefits of VNS may include:
  • Fewer seizures
  • Shorter seizures
  • Faster recovery
  • Fewer medications
  • Decreased seizure severity
  • Improved alertness, mood and memory
  • Improved quality of life

How it works: VNS Therapy is delivered through a device (generator and lead) that sends mild pulses through the vagus nerve to areas of the brain known to be associated with seizures.

VNS Therapy delivers these periodic pulses all day, in an effort to control your seizures.

The procedure: A small device (generator and lead) is implanted during a short, outpatient procedure.

  • Usually takes about an hour
  • Most people go home the same day
  • Involves a small incision in the neck and in the upper check area
  • Under general anaesthetic

Possible side effects of VNS Therapy:
  • Hoarseness/changes in voice tone
  • Coughing
  • A tickling sensation in the throat or on the neck
  • A feeling of Shortness of breath
  • Side effects usually decrease over time and mainly occur during stimulation

Diet

Ketogenic Diet

The ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician and carefully monitored by a dietitian. It is usually used in children with seizures that do not respond to medications. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins.

  • Foods are weighed and measured.

  • The name ketogenic means that it produces ketones in the body (keto = ketone; genic = producing). Ketones are formed when the body uses fat for its source of energy.
  • Usually the body uses carbohydrates (such as sugar, bread, pasta) for its fuel. Because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. The body can work very well on ketones (and fats).
What foods are allowed on a ketogenic diet?

Foods that are generally allowed include high-fat meats, fish,
oils, nuts, high-fat dairy such as cheese, and low-carb vegetables.

Unsurprisingly, reducing carb levels means cutting out bread, pasta, rice, and most conventional baked goods. However, achieving such low levels of carbs also means skipping legumes, root vegetables, most fruits and starchy veggies, such as potatoes.

It is recommended that carbs are limited to 30g for men and 20g for women per day.

How is Epilepsy Treated?

Medication for Epilepsy

Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy do not have seizures. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures.

Deciding on which medicine to prescribe depends on such things as:
  • Your type of epilepsy
  • Your age

  • Possible side effects

  • Other medicines that you may take for other conditions

  • Whether you are pregnant or planning a pregnancy

A low dose is usually started. The aim is to control seizures at the lowest dose possible. If you have further seizures, the dose is usually increased. There is a maximum dose allowed for each medicine.

Surgery

When seizures come from a single area of the brain (focal seizures), surgery to remove that area may stop future seizures or make them easier to control with medicine. Epilepsy surgery is mostly used when the seizure focus is located in the temporal lobe of the brain.

SUBPIAL TRANSECTIONS

Multiple subpial transection (MST) is a surgical technique in which the connections of the epileptic focus are partially cut without resecting it. Palliative surgery for seizure reduction, generally patients does not become seizure free.

CORPUS CALLOSOTOMY

This is an operation that severs (cuts) the corpus callosum, interrupting the spread of seizures from hemisphere to hemisphere.

Seizures generally do not completely stop after this procedure. Seizures usually become less severe, as they cannot spread to the opposite side of the brain.

HEMISPHERECTOMY

The surgeon removes all or portions of the affected hemisphere. The surgeon also gently separates the hemispheres to access and out the corpus-callostum.

RESPECTIVE SURGERY
Temporal Lobotomy
  • Removal of a portion of the temporal lobe of the brain
  • It is the most common type of epilepsy surgery
  • After surgery, 60% to 70% of patients are seizure free

Frontal Lobotomy
  • Removal of a portion of the frontal lobe
  • It is the second most common type of epilepsy surgery
  • After temporal lobotomy 30% to 50% of patients are free of seizures that impair consciousness or cause abnormal movements
VAGUS NERVE STIMULATION

The goal of VNS Therapy is to prevent seizures before they start, and stop them if they do.

Benefits of VNS may include:
  • Fewer seizures
  • Shorter seizures
  • Faster recovery
  • Fewer medications
  • Decreased seizure severity
  • Improved alertness, mood and memory
  • Improved quality of life

How it works: VNS Therapy is delivered through a device (generator and lead) that sends mild pulses through the vagus nerve to areas of the brain known to be associated with seizures.

VNS Therapy delivers these periodic pulses all day, in an effort to control your seizures.

The procedure: A small device (generator and lead) is implanted during a short, outpatient procedure.

  • Usually takes about an hour
  • Most people go home the same day
  • Involves a small incision in the neck and in the upper check area
  • Under general anaesthetic

Possible side effects of VNS Therapy:
  • Hoarseness/changes in voice tone
  • Coughing
  • A tickling sensation in the throat or on the neck
  • A feeling of Shortness of breath
  • Side effects usually decrease over time and mainly occur during stimulation

Diet

Ketogenic Diet

The ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician and carefully monitored by a dietitian. It is usually used in children with seizures that do not respond to medications. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins.

  • Foods are weighed and measured.

  • The name ketogenic means that it produces ketones in the body (keto = ketone; genic = producing). Ketones are formed when the body uses fat for its source of energy.
  • Usually the body uses carbohydrates (such as sugar, bread, pasta) for its fuel. Because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. The body can work very well on ketones (and fats).
What foods are allowed on a ketogenic diet?

Foods that are generally allowed include high-fat meats, fish,
oils, nuts, high-fat dairy such as cheese, and low-carb vegetables.

Unsurprisingly, reducing carb levels means cutting out bread, pasta, rice, and most conventional baked goods. However, achieving such low levels of carbs also means skipping legumes, root vegetables, most fruits and starchy veggies, such as potatoes.

It is recommended that carbs are limited to 30g for men and 20g for women per day.

Who Treats Epilepsy

If the doctor suspects seizures, the person probably will be referred to a neurologist, a doctor with special training in disorders of the brain, including epilepsy.

Some neurologists have specific training in epilepsy and spend most of their time treating people with this disorder; they are called epileptologists

Why Is It Important to Take Anti-Epileptic Drugs Regularly?

The aim of taking anti-epileptic drugs is to obtain adequate control of fits.

It is very important to maintain a constant level of the drugs in the brain to control seizures. In order to achieve that, a constant level of the drug in the blood is required.

It is therefore, very important to take medicines regularly.

If I Forgot to Take My Medicine What Do I Do?

The most common reason for people having a seizure when they have been seizure free is missed medications. This is part of life, everyone forgets to take their medication at some point and most people do not have a problem, however this increases the risk of seizures and SUDEP (Sudden unexpected death in epilepsy) and should be avoided.

We recommend that you should always carry some spare tablets with you in case you do forget to take your tablets. If you remember that you have forgotten the morning dose of tablets before 4 pm you should take the morning dose when you remember and your evening dose as normal. However, if it is after 4 do not take your morning dose and just take your evening dose earlier and then get back on track the following day. It may help to reduce the risk of missing medication by putting an alarm in your phone, using a Dossett box or getting an alarmed pill box

If I Forgot to Take My Medicine What Do I Do?

The most common reason for people having a seizure when they have been seizure free is missed medications. This is part of life, everyone forgets to take their medication at some point and most people do not have a problem, however this increases the risk of seizures and SUDEP (Sudden unexpected death in epilepsy) and should be avoided.

We recommend that you should always carry some spare tablets with you in case you do forget to take your tablets. If you remember that you have forgotten the morning dose of tablets before 4 pm you should take the morning dose when you remember and your evening dose as normal. However, if it is after 4 do not take your morning dose and just take your evening dose earlier and then get back on track the following day. It may help to reduce the risk of missing medication by putting an alarm in your phone, using a Dossett box or getting an alarmed pill box

My Medications Don’t Seem to Be Working. What Should I Do?

If you feel your medications aren’t working, always ask yourself these questions:

1. Am I taking them regularly or am I forgetting to take them on occasion?
2. Do I take them at regular times? (for example, 8 a.m. and 8 p.m.)
3. Have I experienced any recent triggers, such as?

  • Not enough sleep
  • Occasionally drinking too much alcohol
  • Recent illness (cold or flu)
  • Not filling the same formulation of my medication at the pharmacy?

The nursing staff or neurologists will ask you the same questions. Your answers help us understand if your medications really aren’t working or if there are other factors
triggering recurrent seizures. If you feel you are very good at taking your medications as prescribed and cannot identify other triggers, you may need a change in what medications you take or how you take them.

GENERAL EPILEPSY
LIVING WITH EPILEPSY

HELP CHANGE LIVES TODAY

Few people are actually willing to step up and talk about Epilepsy. We need to make the world aware of the impact Epilepsy has on so many and find a cure. Without a cure, there are far too many people who will never have relief from seizures.

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