Epilepsy: Diagnosis, Drugs, Controlling Seizures

by Food and Drug Administration (FDA)

(Page 2 of 3)

Tests may be done to rule out short-term causes of seizures, such as uncontrolled diabetes or infections. A complete neurological exam is done, including an EEG (electroencephalogram, a machine that records brain waves picked up by wires taped to the head). Other tests may include CT (computerized tomography) scanning of the brain, MRIs (magnetic resonance imaging) to check for any growths, scars, or other brain conditions that may be causing seizures, blood tests, and even tests to check heart function. If there is any family history of epilepsy, that is also considered. (For more information about medical imaging technologies, see "The Picture of Health" in this issue of FDA Consumer.)

Although there are over 30 different types of epilepsy-related seizures, there are two broad groups — generalized or partial — depending on the part of the brain affected. Generalized seizures cause loss or alteration of consciousness, involve the entire brain, and affect the whole body. Generalized seizures include grand mal seizures, where the person falls down unconscious as the body stiffens or jerks, and petit mal or absence seizures, where there is momentary alteration of consciousness without abnormal movements. Partial seizures occur when abnormal electrical activity only involves one area of the brain. There are also two kinds of partial seizures: simple seizures, where the person remains conscious, and complex seizures, in which consciousness is lost or altered.

Most epileptic seizures last only a minute or two and are not life-threatening. However, the person who experiences repeated seizures (status epilepticus) and does not regain consciousness between attacks needs immediate attention, as does anyone with prolonged (30 minutes) seizures.

One Drug Does Not Fit All

"For someone newly diagnosed with epilepsy, they need to understand there are many different forms of epilepsy and certain types of medications seem to work best for different types of epilepsy," says Van Hazerbeke.

The need to try different medications in order to find the best combination to prevent seizures — with the fewest possible side effects — sometimes gives families the impression doctors are "experimenting" with their loved one's care, he notes.

"But this is the normal procedure for new patients until their seizures are stabilized," Van Hazerbeke says.

"Many times the side effects determine the drugs. Some drugs can make you gain weight, others have other side effects," says Robert J. DeLorenzo, M.D., a member of the Medical College of Virginia Hospitals/Virginia Commonwealth University's Epilepsy Institute and chairman of the neurology department and neurologist-in-chief at MCV Hospitals. "Taking care of epilepsy patients is an art, not just a science; you need to pick a medication that is clinically a good choice, with the least side effects for the patient. The new drugs are primarily add-on drugs for adding on [to current medications] to difficult cases."

Other Options for Controlling Seizures

In July 1997 FDA approved the first medical device for hard-to-control partial seizures. Cyberonics' NeuroCybernetic Prosthesis (NCP) system or vagus nerve stimulator, approved for adult and adolescent patients, is surgically implanted on the left side of the chest with a lead running under the skin to the vagus nerve on the side of the neck.

The flat, round, thin device, which includes a battery pack and computer chip, is set by a neurologist to discharge in bursts of about 30 seconds each, every five minutes a day, 24 hours a day. The stimulation has the effect of preventing seizures in some people. People generally must continue to take medications as well.

Surgery as an option for treating epilepsy is used only in rare instances.

"Anyone that has intractable epilepsy, with seizures occurring in spite of good medications, should be evaluated," DeLorenzo says. "If they have a focal area [of the brain] that can be operated on, you can either cure the seizures or make them treatable."

Forty-one-year-old Martha Curtis is one epilepsy sufferer for whom surgery worked. Diagnosed with epilepsy at age 3, her life was a haze of multiple drugs and seizures before she decided to opt for surgery.

A professional concert violinist, Curtis recalls that she would have seizures periodically on stage: "I knew what was happening and it was horrifying. The actual difficult part was I perceived I was going to be killed [by the seizure], which was much scarier than 'oh no, I'm going to be embarrassed.' "

After experiencing four grand mal seizures in one month in 1990, Curtis decided to check out surgery as an option. She wound up having three operations.

"After the third surgery, I did real well the terror was cut off. This is magic I have fallen in love with uninterrupted consciousness!" she says with a laugh.

Curtis still takes two medications, phenobarbital and Lamictal.

According to The Epilepsy Foundation, surgery to remove injured brain tissue and control seizures requires thorough evaluation, including the recording of a seizure with EEG and neuropsychological testing to determine if someone is a good candidate for surgery. Such testing can help a physician determine if there is a part of the person's brain tissue good for nothing but generating seizure activity.

Another, more debated type of treatment is the ketogenic diet, a special high-fat, low-carbohydrate diet used mainly in children and sometimes prescribed as a treatment option for those with intractable epilepsy. The diet results in ketosis, a condition in which excessive amounts of ketones (substances chemically akin to acetone) are produced, resulting in an anti-epileptic effect.

DeLorenzo says much is still unknown about the diet: "How does it work? How well does it work compared to current medications? It is a very tough diet to go on; if you draw blood [from someone on the diet] there is so much fat the blood looks creamy. It does work well for some people, but if it worked well for everyone [with epilepsy], everyone would be on it."

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