Antiepileptic drugs successfully prevent seizures in the majority of people who take them regularly and as prescribed. It has been estimated that at least fifty percent of all patients with epilepsy gain complete control of their seizures for substantial periods of time. Another thirty percent enjoy a significant reduction in the number of seizures. If patients, in collaboration with their physicians, decide to attempt withdrawal from medications, they should be aware that the seizures may recur and should closely observe seizure precautions. Some individuals, however, have an excellent chance of remaining seizure free without medication in the future.
Unfortunately, some people continue to have seizures regularly despite taking medication. There is hope that continuing research will produce new drugs, and new ways of using them, that will eventually give seizure relief to everyone who has epilepsy.
Surgery for epilepsy is a delicate, complicated operation and may not be a recommended option in all cases. It is usually done at special medical centers that treat patients with epilepsy rather than at local hospitals. In addition to operations that remove a small part of the brain where seizures begin, other procedures may be done to interrupt the spread of electrical energy in the brain.
Patients anticipating epilepsy surgery may have several special tests first. In some cases, electrodes have to be implanted in a separate operation to locate seizure sites deep in the brain. These tests may take days or even weeks to complete. In some cases, the patient may be awake during part of the operation (this is not usually the case with small children): this is possible because the brain does not feel pain. Having the patient awake helps the doctors ascertain that crucial areas of the brain are not damaged.
After surgery, seizure medications may need to be continued for a year or two. If no further seizures occur the medicine may be slowly withdrawn. At this point, chances of living free of seizures and free of medication are good although some patients may have to continue with medication.
Vagus Nerve Stimulation
Vagus nerve stimulation therapy is another form of treatment that may be tried when medications fail to stop seizures. It is currently approved for use in adults and children over the age of 12 who have partial seizures that resist control by other methods. The therapy is designed to prevent seizures by sending regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck.
The electrical pulse is delivered by a battery which is surgically implanted in the chest wall. Electrodes are threaded under the skin and wound around the vagus nerve in the neck. The battery is programmed by the health team to send a few seconds of electrical energy to the vagus nerve every few minutes. If the person with the system feels a seizure coming on, he or she can activate the discharge by passing a small magnet over the battery. In some people, this has the effect of stopping the seizure.
Side effects of VNS therapy are mostly hoarseness or discomfort in the throat. Although complete seizure control is seldom achieved, the majority of people who use VNS therapy experience fewer seizures. In some patients the effectiveness increases with time rather than producing immediate effects. It will almost always be necessary to continue anti-epileptic medication, although the patient should be able to reduce dosages.
Our bodies run on energy from the glucose which we get from food, but we can't store large amounts of glucose: we only have about a 24-hour supply. When a child uses up all the stored glucose, the body begins to burn stored fat. The ketogenic diet maintains this process by keeping calories low and making fat products the primary food, forcing the child's body to burn fat; in fact, the diet produces up to 80 percent of its calories from fat with the remainder composed of carbohydrates and protein. Each meal has about four times as much fat as protein or carbohydrate.
Placing a child on the diet without medical guidance puts a child at risk of serious consequences. Every step of the ketogenic diet process must be managed by an experienced treatment team, usually based at a specialized medical center.
The amounts of food and liquid at each meal have to be carefully measured for each person. Doctors don't know precisely why a diet that mimics starvation by burning fat for energy should prevent seizures, or why the diet works for some children and not for others, but research is continuing. Approximately one third of children using the ketogenic diet become seizure free, and another third have shown marked reductions in the frequency of seizures. The rest either do not respond at all or find it too hard to continue with the diet due to side effects or food intolerance.
Most experts consider the diet as an option when two or more medications have failed to control seizures, or when medications cause side effects that are having a harmful effect on a child's life. It also helps to have a child who is willing to try foods that they may otherwise not be enthusiastic about.
The ketogenic diet lacks several important vitamins which have to be added through supplements. Sometimes high levels of fat build up in the blood, especially if a child has an inborn defect in his ability to process fat; this possibility can lead to serious effects, which is another reason for careful monitoring. Adult women on this diet may experience menstrual irregularities, Pancreatitis (inflammation of the pancreas), decreased bone density and certain eye problems; again, this demonstrates a need for a medical team to closely follow patients who are on the diet.
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