Epilepsy (Part 2): Treatment

Epilepsy is a chronic neurological disorder, characterised by the onset of recurrent seizures (abnormal electrical activity in the brain), that affects 50 million people of all ages worldwide.

Following on from the first part on epileptic seizures and the diagnosis of epilepsy, renowned consultant neurologist, Dr Katia Cikurel, offers a comprehensive insight into the medical concerns for women who are diagnosed and the most common treatments available, in this conclusion of a two-part series on epilepsy.

Are there any special concerns for women who are diagnosed?

Yes, there certainly are special concerns for women who are diagnosed with seizures. Most of these revolve around certain types of medications used to treat seizures, and the possible side effects that these medications can have on the efficacy of the oral contraceptive pill and on a developing fetus - if a woman becomes pregnant.

However, there are excellent seizure medications available that do not interact with the oral contraceptive pill as well as alternatives to the combined contraceptive pill, such as depot preparations and the Mirena coil. Non-hormonal contraceptive methods that have no interaction with any anti-epileptic medication are also available. As a result, it is important for women to tell their doctor if they are on, or considering, oral contraception whilst taking anti-epileptic medication.

Moreover, there are also several anti-epileptic medications that are considered safest for those who are planning to become pregnant. Any woman of child-bearing age who may become pregnant, whether planned or not, should have a discussion with their doctor. This should include a discussion about which medications are best for pregnancy as well as additional factors, such as taking a higher dose of folic acid (5mg) pre-conception to help reduce the risk of neural tube defects in the fetus.

No woman of child-bearing age should be taking Sodium Valproate (Epilim), as this has shown to lead to a number of physical and longer lasting developmental issues in the fetus. If there is no other choice, a woman taking sodium valproate must sign a yearly agreement stating that she understands the risks and will take all precautions to prevent pregnancy whilst taking sodium valproate.

How is epilepsy commonly treated?

Epilepsy is usually treated with one or more anti-epileptic medications.

There are now many different anti-epileptic drugs available - many of which have different modes of action. Therefore, if one medication does not help with a person’s seizure frequency or intensity, then the medication can be changed to a different one with an alternative mode of action.

Ideally, monotherapy (using only one medication) is recommended. However, often, a combination of different anti-epileptic medications is required to provide the best result.

Most people who have more than two seizures will start with anti-epileptic medication. In some cases, treatment will start following the first seizure - especially if there is a structural reason that can explain why the seizures occurred.

Sometimes, people who present with childhood epilepsy become seizure-free as they grow older. In this situation, medication may be withdrawn. Likewise, medication may also be withdrawn if a person presents with a seizure with a large tumour - especially if the tumour is benign (for example, a meningioma) and if the tumour is completely removed and no further seizures occur post-op.

However, in many cases, medication may need to be continued long-term. Doctors will always try to find the medication that best suits the person.

In a few cases of focal onset epilepsy, even if there is no obvious lesion at the site of onset of the seizures, it may be possible to identify the specific area of the brain where the abnormal electrical activity arises to carry out very targeted epilepsy surgery.

In some people who have resistant seizures despite a combination of anti-epileptic medication, the insertion of a vagal nerve stimulator can sometimes improve the frequency and the intensity of ongoing epileptic activity.

Can changes in diet help?

In most cases, diet does not have a particular effect on seizures. However, alcohol is known to have the potential to lower seizure threshold and therefore, make seizures more likely (especially when drunk in excess.)

In certain cases of severe and resistant epileptic seizures, a ketogenic diet may be helpful. However, this is not recommended long-term, especially for people with intermittent seizures.

If you have been experiencing epileptic seizures, do not hesitate to reach out to Dr Katia Cikurel to discuss your case and receive advice and treatment from an expert.