Introduction
There are a number of therapeutic and drug options for the treatment of epilepsy which are presented below.
Therapeutic possibilities
The therapy of epilepsy should be as causal as possible. This means that if a cause is known, it should be treated. If the cause is unknown, epilepsy can in principle be treated both medically and surgically.
The patient should always receive detailed advice on how to live. This includes, for example, information on the rhythm of sleep or on how to avoid triggers such as alcohol. Genetic counseling should also be offered if necessary.
Drugs are usually only used when at least two unprovoked seizures have occurred; a single seizure alone is not sufficient as a treatment indication. However, there are exceptions, for example, when epilepsy is a vital threat, or in certain social circumstances, e.g. in some professions. Furthermore, there are also exceptions in the presence of changes in the EEG that are typical of epilepsy.
Under certain circumstances, the medication does not have to be taken for life: If no seizures occur for 2-3 years while taking the tablets, they can be gradually reduced over a period of 6-12 months and finally discontinued completely. If drugs do not show any efficacy, surgical intervention remains as an alternative. The prerequisite for this is the presence of a focal point in the brain responsible for the epileptic seizures or a great deal of suffering on the part of the patient.
The fact that at least two drugs have not shown any efficacy is also an indication for surgery. If a focus is present, it can be surgically removed; if there is no focus, a vagus stimulator may be used. This is a device that stimulates a nerve, the vagus nerve, and thus influences the development of seizures.
The status epilepticus is treated according to a graduated scheme. First, lorazepam is given for generalized seizures and conazepam for focal seizures. If this is not effective, phenytoin is administered.
Finally, the patient is intubated and given phenobarbital. Initially, monotherapy is sought. This means the use of only one drug from the group of antiepileptic anticonvulsants. If the drug is not effective, another member of this group should be administered first and only if it is again ineffective should a combination therapy with a second antiepileptic drug be started.
