Epilepsy Patient Care

Epilepsy is a condition where a patient has recurrent unprovoked seizures. It occurs in about 1% of the general population. It could be divided into two main groups. One is partial (focal) epilepsy where the seizures start at one or more discrete locations of the brain. The other is generalized epilepsy where EEG (brain wave study) will demonstrate simultaneous seizure discharges over the entire brain surface. Patients with generalized epilepsy are not candidates for epilepsy surgery. The clinical symptoms during a seizure will depend on the part of the brain that is involved. For patients with partial seizures, they may have an aura, the warning that a more severe seizure may start soon. Once a large enough area of brain is involved, then the patient will lose contact with the environment. Most seizures terminate within one-to-two minutes. If not, medical attention should be sought immediately.

Antiepileptic drugs (AEDs) could be divided into two main groups. The first generation of AEDs include Phenytoin (Dilantin), Carbamazepine (Tegretol), Phenobarbitol, Primidone and Valproic acid (Depakote). The secondary generation AEDs include Lamotrogen (Lamictal), Topiramate (Topamax), Levetiracetam (Keppra), Zonisamide (Zonegran), Felbamate (Felbatol), Gabapentin (Neurontin), Tiagabine (Gabitril) and Vigabatrin (Sabril). Please see medlinePlus Web site for more information regarding each drug.

For patients with partial epilepsy, about 70% of them will have good seizure control with one or more anticonvulsants. However, for the rest 30%, patients continue to have recurrent breakthrough seizures despite being treated by two or more anticonvulsants for long enough time and at adequate doses. This group of patients could benefit from being evaluated for possible epilepsy surgery which, if performed in carefully selected patients, could provide 50-90% chance of achieving seizure freedom. The remaining 10-50% will also benefit from dramatic reduction in seizure frequencies. For those who deemed not good surgical candidates, vagal nerve stimulator (VNS) implantation could provide 40% chance of having their seizure frequencies cut down by half.

Vagal Nerve Stimulator (VNS) is a small pacemaker-like device that can be surgically implanted in the left chest wall. It has leads that attach to the left vagus nerve. The device sends intermittent electrical impulses to the left vagus nerve, which in turn sends signals to brain to help control seizures. The VNS is reserved for epileptic patients who are resistant to anticonvulsants and deemed not good candidates for epilepsy surgery.