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Reviewed by Dr Dan Rutherford, GP
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Treating epilepsy
Epilepsy is usually
treated with
medicines. In this way, it is
possible for 60-70 per cent of those recently diagnosed with epilepsy to avoid
fits, with no or minimal side effects.
Monotherapy (single drug therapy)
The most appropriate medicine is administered in the smallest
dosage possible. If fits recur, dosage is gradually raised until they cease or
the medicine causes negative side effects.
Multidrug therapy
If one kind of medication does not work, a second is added. If
the patient's attacks stop, the first medicine is reduced, since most
people can be treated with just one type (monotherapy). If the epilepsy is
difficult to treat, it might be necessary to try other medicines. However, if
additional medicines prove ineffective, the chance of controlling the attacks
is reduced.
How does the doctor determine the dosage?
The level of medicine in the blood is often measured to
determine its effect on the fits. It is important to remember that therapeutic
levels (and their side effects) for epileptic patients are only guidelines and
that every patient should be treated individually.
How often should the medicine be taken?
Most medicines given to treat epilepsy are taken in one or two
doses a day. No matter how the patient feels, it is important to take the
medicine on a regular basis to achieve satisfying results. Forgetting to take
it might trigger an attack.
What kind of medicine should be used?
Various medicines are available for different types of epilepsy.
Some types are fairly specific, only having an effect on certain kinds of
epilepsy, while, in other cases, they have no effect, or might even raise the
risk of attacks. In complicated cases of epilepsy, it is often a difficult task
for the doctor to find the right treatment.
How to keep a diary of attacks
It is vitally important for patients to make a note of the date
and intensity of their attacks. The frequency and severity of fits are the only
guidelines to how well a treatment is working. Without this information, it is
difficult or even impossible to know whether it is effective or not.
Treatment during pregnancy
Counselling before conception is essential, since, for various
reasons, it is important to plan the pregnancy in advance. Mothers suffering
from epilepsy run a higher risk (5 per cent compared to about 1 per cent) of
giving birth to babies with congenital deformities.
A supplement of
may
reduce the risk, but this has to be given before conception and then every
day until birth. In addition, the need for medication generally increases
during pregnancy and the dose has to be raised.
Reducing the medication
If attacks have been successfully controlled for a few years
(about five for adults and two to three for children), it is common practice to
gradually reduce the amount of medicine taken.
If the attacks recur, it is usually possible to control them by
recommencing the medicine.
Patients should never stop taking their medicine without
consulting a doctor, due to the risk of increased attacks.
Is an operation possible?
If it is impossible to gain control of the epilepsy using
medicine, an operation should be considered. This kind of treatment is normally
used in cases of epilepsy of the temporal lobe.
Nevertheless, surgery can only be considered in cases where
there is only one focus for the epilepsy, and when it can be removed without
any risk of permanent injury (paralysis, speech disturbances etc). This,
unfortunately, is only possible in a minority of cases.
Support groups
-
Epilepsy Action
-
National Society for Epilepsy
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Based on a text by Dr Jørgen Alving, specialist
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Last updated 01.08.2005
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