Treatment
In the drug therapy of epilepsy, a distinction must first be made between two groups. On the one hand, there are drugs that must be taken daily by the affected persons and which act as a prophylaxis to avoid seizures. On the other hand, there are drugs that are for the acute case, i.e. they have to be taken shortly before a seizure occurs.
The general goal of the doctors is to achieve freedom from seizures, either by eliminating symptomatic factors or by a well adjusted drug therapy. Which drug is used depends on the type of seizure. The prophylactic drugs are summarized as so-called anticonvulsants.
There are now more than 20 different active ingredients in this group of drugs, each of which has a different spectrum of activity and is associated with different side effects. The most important “anticonvulsant” drugs here are Carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, topiramate, valproic acid In the case of focal epilepsies, lamotrigine and levetiracetam are prescribed above all, while in the case of generalized epilepsies it is rather valproic acid or topiramate. In contrast, no drugs are prescribed for individual rare seizures, i.e. less than 2 seizures per year.
The exact dosage and a possible combination of these drugs are adapted to each patient individually, as the focus of therapy is different in each case. However, it is possible that different drugs may have to be tried out during the course of the disease, as not everyone responds equally well to the drugs. Thus, therapy with the first drug leads to permanent seizure-free survival in only about 50% of patients.
Once a patient has been set up with the right medication, the patient usually has to take it for the rest of their lives. Otherwise, it is important that the medication is taken regularly and that careful adjustment and monitoring is carried out. If an anticonvulsant medication is discontinued, a creeping intake is required.
This means: At the beginning a small dose should be given, which is increased in the course of time until the desired concentration is reached in the blood. During monitoring, the focus is on the blood values, as they can be easily checked and the drug can also be detected in the body and its concentration.Only after a three-year absence of seizures with normal EEG findings can an end to the drug treatment be considered. A gradual decrease should take place.
An operative measure should only be considered if no single or multiple drug therapy has been successful. An isolated area in the brain that causes epilepsy is another prerequisite. In addition, no areas in the brain that perform important functions may be injured or removed during the operation.
If the seizure disorder is severe and involves a larger area of the brain, partial brain removal (brain amputation) may be considered as the last possible solution. In preparation for surgical treatment, an EEG and computer tomography imaging are necessary to find the exact location of the seizure site. Temporal lobe epilepsy foci are particularly suitable for surgical therapy.
If an acute seizure occurs, an epileptic seizure is first treated with benzodiazepines. The best-known drugs in this group of drugs include Tavor and Valium. If these drugs do not bring the desired success, other drugs such as phenytoin or clonazepam are available in reserve.
In addition to drug treatment, there are general life measures that should be followed. Plenty of sleep and the renunciation of alcohol are as much a part of it as the driving ban. However, there are specific rules for this: A driving license is issued when the person has been seizure-free for two years, has no noticeable EEG and the drug treatment is regularly checked by a doctor.
Furthermore, epilepsy has an impact on the profession or the choice of profession. Drivers or locomotive drivers, as well as those workers who have to climb ladders and scaffolding, should think about changing their profession. Since the status epilepticus is a life-threatening situation, it should be treated as soon as possible.
This is done by administering a benzodiazepine through a needle in a vein. If the benzodiazepine does not have an antispasmodic effect, valproate is used first and then phenytoin, an anesthetic. Since about 8% of the population suffers from an epileptic seizure once in their lifetime, it is useful to be informed about first aid measures for this situation.
For observers, an epileptic seizure usually looks very frightening and, which is absolutely correct, the emergency doctor is quickly called. In almost all cases, an epileptic seizure is accompanied by a spasm of the entire musculature, which leads to uncontrolled twitching of the body. It is often attempted to fix the patient in order to suppress these twitches.
However, this should be avoided under all circumstances, as the body develops such great forces during a seizure that dislocation of joints or fractures can occur. In addition, no attempt should be made to push anything between the teeth of the person affected, as this can lead to fractures of the jawbone. In such a seizure there is usually little that first responders can do except to make an early emergency call and memorize the exact course of the seizure, as this is very important for diagnosis.
In most cases, the patient wakes up slowly when the emergency doctor arrives, but he is usually confused and disoriented. In addition to giving an electrolyte infusion, the doctor will take blood samples to measure the levels of antiepileptic drugs and determine the alcohol level. If a seizure occurs again within the next few minutes, this is known as the status epilepticus and requires immediate admission to an emergency room.