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What is Epilepsy and how it is treated? – Part 2

• Epilepsy is a condition in which the patient has seizures.
• Epilepsy can be treated and controlled.
• Seizures or fits in about 60-70% patients with epilepsy can be treated and controlled using one simple and inexpensive drug.
• Epilepsy surgery in carefully selected patients can even cure epilepsy.
• With a correct treatment approach, most patients with epilepsy can enjoy life as much as a healthy person can.

Drugs used only in the treatment of refractory status epilepticus include:
• paraldehyde (Paral)
• midazolam (Versed)
• pentobarbital (Nembutal)

Safety and Side Effects
• mood changes
• sleepiness
• unsteadiness in gait
• drug rashes
• liver toxicity (hepatitis)
• aplastic anemia

Epilepsy Surgery

• Epilepsy surgery is an option for people with focal seizures that remain resistant to treatment.
• The goal for these procedures is total control of epileptic seizures.
• But still anticonvulsant medications may be required.
• The evaluation for epilepsy surgery is designed to locate the “epileptic focus”.
• This is also to determine if respective surgery will affect normal brain function.
• Physicians will also confirm the diagnosis of epilepsy to make sure that spells arise from epilepsy.

The evaluation typically includes:
• neurological examination
• routine EEG
• long-term video-EEG monitoring
• neuropsychological evaluation

Neuro imaging such as:
• MRI
• Single photon emission computed tomography (SPECT)
• Positron emission tomography (PET)

Some epilepsy centers use below as supplementary tests:
• Intracarotid sodium amobarbital test (Wada test)
• Functional MRI
• Magnetoencephalography (MEG)

Certain lesions require:
– Long-term video-EEG monitoring.
– Brain mapping by the technique of cortical electrical stimulation or Electrocorticography.
• The most common form of intractable epilepsy in these disorders in adults is temporal lobe epilepsy with hippocampal sclerosis.
• The most common type of epilepsy surgery is the anterior temporal lobectomy, or the removal of the front portion of the temporal lobe including the amygdala and hippocampus.
• Some neurosurgeons recommend selective amygdalahippocampectomy.
• Palliative surgery for epilepsy is intended to reduce the frequency or severity of seizures.
• Examples are callosotomy or commissurotomy to prevent seizures from generalizing.
• Multiple subpial transection can also be used to decrease the spread of seizures across the cortex.
• Resective surgery can be considered palliative if it is undertaken with the expectation that it will reduce seizures.
• Hemispherectomy involves removal or a functional disconnection of most or all of one half of the cerebrum.

Other Options

• Ketogenic diet (high-fat, low-carbohydrate)
• Electrical stimulation
• Vagus nerve stimulation
• Responsive neurostimulator system (US
• Deep brain stimulation
• Noninvasive surgery using the gamma knife
• Anterior temporal lobectomy

What is Avoidance Therapy?

• It consists of minimizing or eliminating triggers in patients whose seizures are particularly susceptible to seizure precipitants.
• For example, sunglasses that counter exposure to particular light wavelengths can improve seizure control in certain photosensitive epilepsies
Canine warning system.
• A seizure response dog, a form of service dog, is trained to summon help or ensure personal safety when a seizure occurs.
• These are not suitable for everybody.
• Not all dogs can be so trained.

What is Seizure Prediction?

Seizure prediction based devices using long-term EEG recordings are presently being evaluated as a new way to stop epileptic seizures before they appear clinically.

Alternative or complementary medicine
• acupuncture
• psychological interventions
• vitamins
• yoga
• meditation techniques
• cochrane Collaboration
• exercise
• other physical activity

Epilepsy: Patient and Family Guide Treating Epilepsy Naturally Seizures and Epilepsy in Childhood

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