Treatment of Epilepsy

Take medication according to the neurologist’s indications. Be careful not to forget any doses of medication. 

Get enough sleep and follow a regular sleep schedule.

Avoid alcohol consumption.

Do not do drugs.

Reduce stress levels.

Eat a healthy and varied diet and carry out suitable physical exercise.

Follow recommendations regarding activities such as driving which, in the case of active epilepsy, can imply a risk for the patient and other people.

Fever or certain medications can also trigger seizures. Before taking other medicines, you should check that they are suitable for use in patients with epilepsy and do not affect the antiepileptic drugs you may be taking.

Some patients notice a specific sensation before losing consciousness during a seizure. This feeling is called an aura. Patients eventually recognise their auras and should take precautions to avoid injuries (e.g., sit down).

Antiepileptic drugs can achieve long-term remission in 60–70% of patients, but some need to take a combination therapy.

The doctor will probably prescribe just one drug at a relatively low dose and then gradually increase it until the seizures are well controlled.

Whenever the antiepileptic treatment does not achieve seizure control (usually after trying at least two drugs), it may be considered a case of drug-resistant epilepsy and the patient should be referred to a specialist unit to assess if they are a candidate for other treatments such as surgery or neurostimulation. For cases where these treatments are not applicable, other drugs must be tried as they may prove beneficial for some patients.

Following a period of 2 to 5 years without any seizures, the neurologist may recommend a controlled withdrawal of the medication, so long as they believe there is little risk of recurrence and the patient follows the appropriate precautions.

In recent years, new specific pharmacological therapies and some highly effective drugs have been developed for certain epilepsy syndromes. If epileptic attacks are not well-controlled, expert assessment to consider therapeutic alternatives is advised. 

To determine whether a patient with drug-resistant epilepsy is a candidate for surgery they need to undergo a complicated presurgical evaluation involving video–EEG monitoring, a brain MRI (magnetic resonance imaging) and a neurological, psychiatric and neuropsychological assessment. In certain cases, functional neuroimaging tests (PET, SPECT, etc.), functional magnetic resonance imaging or an invasive electrode study must be conducted. These are performed to locate the position of the epileptic focus in the brain and to evaluate if the advantages of an intervention outweigh the potential risks.

There curative procedures, generally associated with the removal of some brain tissue where seizures begin, and palliative procedures, which may reduce the number of seizures but do not usually eliminate them completely, such as vagus nerve stimulation. The expected benefits and potential negative effects must be identified for each individual; these will depend on the type of surgery, the type of epilepsy and the patient’s characteristics. New surgical techniques, such as MRI-guided laser surgery and stereo-EEG-guided thermocoagulation, have emerged in recent years. Radiosurgery can be used to treat lesions with locations that are difficult to access through conventional surgery, such as hypothalamic hamartomas.

In the case of drugs, two types of adverse effects are distinguished:

• Adverse effects related to the central nervous system and depending on the dose: dizziness, nausea, instability, double vision, headache, changes in mood or behavior and cognitive alterations.
• Idiosyncratic or unpredictable adverse effects, for example alterations in blood cells, hepatitis and allergies.
• Fetal malformations and developmental delay. Medicines taken by the mother during pregnancy can cause fetal malformations and delayed development, so the pregnancy must be properly planned by choosing the safest medicines for the mother and the baby.

There are certain complications associated with the surgical procedures used to treat epilepsy, for instance, wound infections or central nervous system infections (meningitis, encephalitis), brain haemorrhages or stroke, and cerebrospinal fluid leaks.

Other complications depend on the type of surgery and the area operated on. These risks must be discussed at length with the patient and their family.