Diagnosis & Treament
The goal of epilepsy treatment should be “no seizures and no side effects.” Not everyone will be able to reach that goal, but doctors and patients should always be working toward it together. A strong doctor-patient relationship, access to needed treatments and healthcare services, and healthy behaviors all contribute to successful management of seizures. Epilepsy Foundation of Michigan staff can work with you to make sure you’re doing everything you can to manage your seizures.
 

Diagnosis
An accurate diagnosis increases the chances of successful treatment. Epilepsy can be confused with nonepileptic seizures and many other conditions. Doctor’s must rule out these other conditions before making a diagnosis of epilepsy. In addition, diagnosis should include information on what type of epilepsy is suspected, what type of seizures are being experienced, and what to expect in the future.
 
A variety of tools can help doctors with diagnosis, including electroencephalography or EEG (standard EEG, ambulatory EEG, video EEG monitoring), neuroimaging technologies (MRI, CT, PET, SPECT, MEG, MRS), neurological exam, physical exam, and blood tests. Perhaps the most important diagnostic tool, however, is the medical history. This provides the doctor with important information on what happened before, during, and after each seizure and can give clues regarding a possible cause.
 
Useful Links:    
       

 

Treatment
Typically the first treatment tried in patients with epilepsy is daily medication. There are over 20 antiepileptic drugs (AEDs) available. The term “antiepileptic drug” is actually a misnomer, as these medications do not treat the underlying condition of epilepsy, but instead prevent seizures, the main symptom of epilepsy. Most people with epilepsy are able to get complete seizure control by taking one ore more AEDs; however, in about 40% of patients, seizures continue despite treatment.
 
If you have tried two to three appropriate medications, and you’re still having seizures or significant side effects, you should see an epileptologist (a neurologist who specializes in epilepsy) to review your current treatment regimen and discuss other treatment options. Most epileptologists work at Comprehensive Epilepsy Centers, which feature a staff of epilepsy experts, including clinical nurse specialists, neurosurgeons, neuropsychologists, and others, and access to the full array of diagnostic and treatment options.
 
When medications don’t work, the following treatment options may be considered:
 
  • Brain Surgery – If your seizures are starting in a single part of the brain that can be safely removed without damaging important functions like movement, vision, or speech, you may be a candidate for brain surgery. The most common type of brain surgery removes the seizure-producing part of the brain and results in seizure freedom for the majority of patients. Although risks need to be carefully considered, surgery should no longer be thought of as a last resort. In appropriate candidates, surgery early in the course of the condition offers the best chance of becoming seizure free and maintaining quality of life.
  • Vagus Nerve Stimulation – Patients who are not candidates for brain surgery and for whom medication is not working may consider vagus nerve stimulation. A vagus nerve stimulator (VNS) is a pacemaker-like device implanted under the skin on the chest wall with leads that attach to the vagus nerve in the neck. The device is programmed to periodically stimulate the brain via the vagus nerve. For some people, this reduces the frequency or severity of seizures. It also offers an added sense of control because a magnet that comes with the device can be used to activate it if an aura is experienced or if a seizure has already begun. This can sometimes prevent, stop, or shorten a seizure. It is rare that people become seizure-free by using the VNS; however, it can often improve seizure control and/or quality of life.
  • Ketogenic Diet – The ketogenic diet is a high-fat, low-carbohydrate diet that, for reasons not fully understood, can improve seizure control in some people with epilepsy. It must be done under the supervision of a doctor and a dietician, foods must be carefully measured out, and rules must be strictly followed. Because the diet is not particularly pleasant and can be difficult to follow, it is used primarily in young children. About a third of children who use the ketogenic diet become nearly or entirely seizure free. Another third improve but continue to have some seizures. The rest either have no improvement or discontinue the diet because of side effects or because they can't tolerate the food.
  • Complementary Therapies – Several other promising therapies for epilepsy have been studied but don’t yet have enough evidence to support their routine use; however, if your doctor agrees that a therapy is safe, affordable, and possibly effective, it might be worth trying in addition to your standard treatment. Keep in mind, several therapies that claim to help with seizures can actually make seizures worse, interfere with antiepileptic medications, and cause other health problems.
 
Useful Links: