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Epilepsy

Epilepsy Diagnosis and Treatment

Epilepsy is a neurological disorder in which the brain experiences abnormal, synchronous behavior which results in a seizure. About one in 100 people in the United States have experienced an epileptic seizure or been clinically diagnosed with epilepsy.

About 80% of these cases can be easily treated with medication or surgery, while the remaining patients currently untreatable. In some cases, usually involving children and adolescents, symptoms may simply end.

Diagnosis

Before diagnosing epilepsy, a thorough review of medical records of past seizures are consulted and blood tests are run to ensure that epilepsy is indeed the reason the seizures are occurring.

Epilepsy is diagnosed using:

Brain imaging is the most useful tool for clinically assessing epilepsy. When combined with symptom observation epilepsy experts are able to confidently diagnosis the type of epilepsy and make a recommendation about how to treat the condition. The imaging techniques used to assess brain function vary but include CT (computed tomography) scans, fMRI (functional magnetic resonance imaging), or the non-visual EEG which yields graphs of electrical activity.

Treatments

Medications

As mentioned in the introduction the first line of defense against epilepsy is a pharmaceutical option as prescribed by their doctor. This is the least imposing on the patient and more often than not proves effective. Commonly prescribed drugs include:

These medications can suppress symptoms, but other medications may be needed for specific types of epilepsy. Once the drug has kept the patient seizure-free for a long period of time (usually between two and five years) doctors will recommend that the patient cease its use.

Surgery

The second option for treating epilepsy is usually surgery to remove the part or parts of the brain malfunctioning that are causing the seizures. Doctors make their diagnosis about how appropriate surgery is depending on the chance for negative effects associated with the section of the brain to be removed. If the seizures occur in the motor cortex, for example, paralysis is a potential outcome and may make the patient unsuitable for surgery.

Implantation

A third treatment for epilepsy is device implantation. A vagus nerve stimulator is a fairly recent biomedical technology approved by the U.S. Food and Drug Administration in 1997 to help control seizures. Once implanted, the device stimulates the vagus nerve. This treatment is only mildly effective as it reduces most patients' seizures by 30% on average. Also, before considering this option, patients should be aware that they will need to continue taking their antiepileptic medication post-implantation.

Sources:

National Institute of Neurological Disorders and Stroke ? Seizures and Epilepsy: Hope Through Research

Carlton-Ford, S., Miller, R., Brown, M., Nealeigh, N., Jennings, P. (1995). Epilepsy and Children?s Social and Psychological Adjustment. Journal of Health and Social Behavior, Vol. 36, 285-301.

Prepared in partnership with Kevin McHugh, BS (class of 2009), Case Western Reserve University School of Engineering.

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Last Reviewed: Oct 07, 2010

David M Ficker, MD David M Ficker, MD
Associate Professor
College of Medicine
University of Cincinnati