Epilepsy is one of the most common neurological disorders, affecting 3.4 million Americans or 1 in 26 over a lifetime. The hallmark of epilepsy is seizures caused by abnormal bursts of electrical energy in the brain that can lead to convulsions and loss of consciousness followed by disorientation. Everyday activities like cooking and driving can be dangerous.
Although there are about 30 epilepsy medications, one-third of patients do not become seizure-free.
Vikram Rao , MD, PhD, is the division chief of the UCSF Comprehensive Epilepsy Center and a leading researcher on implanted devices. He explains how these treatments may have life-changing effects. And he reveals ongoing research that may offer relief to many more patients.
Why don't medications work for some patients?
Just 1 in 5 patients who do not become seizure-free with medications find their way to a comprehensive epilepsy center, which offer the broadest range of diagnostic evaluations and advanced treatments.
The biggest reason medications don't work is because the patient may not have epilepsy. Determining this may require patients to undergo seizure monitoring by specialists like those at UCSF Comprehensive Epilepsy Center . Among this group, the most common misdiagnosis is psychogenic non-epileptic spells (PNES), which is seen in about 25% of patients at specialized epilepsy centers. It may mimic epilepsy, but it's psychological in origin and is usually seen in people with a history of trauma. These patients shouldn't be treated with anti-seizure medications.
Also, some people with epilepsy cannot tolerate anti-seizure medications at the doses needed to control seizures. And sometimes medications are ineffective for reasons we don't understand.
If medication doesn't work, what other options are available?
If you ask patients what's the worst thing about epilepsy, they often say the side effects of medications. Anti-seizure medications work by dampening electrical activity in the brain. But they don't discriminate very well between seizure activity and normal "housekeeping" brain activity that helps us think and feel and remember. So, many medications cause dizziness, fatigue, incoordination, and brain fog. While some types of epilepsy go into remission, most patients require lifelong treatment.
Another treatment option is surgery. This involves removing the brain tissue that is causing seizures. But even with the most successful surgery, stopping medicines too quickly doesn't usually go well. If patients are seizure-free one year after surgery, we'll talk about slowly tapering, but some people still need medications for the long haul.
