Epilepsy treatment

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?".The treatment of epilepsy is drugs and other means designed to relieve the symptoms of the disease and influence the cause in order to eliminate the acute manifestations of this pathology. For different varieties of epilepsy, different drugs and their combinations are used. In 70% of cases, epilepsy can be effectively treated with medications that help control the course of the disease.

Concomitant therapeutic measures in the form of diet, daily regimen, folk remedies can qualitatively supplement the main therapy. Treatment begins with a diagnosis based on diagnostic procedures by medical professionals. Self-treatment for epilepsy can be dangerous not only for health, but also for the life of the patient and others, since seizures at work, for example, can lead to injury to people.

Is a complete cure possible

Acquired epilepsy can sometimes be completely cured. However, this disease has a peculiar character, in patients the behavior during attacks can change significantly, which may partially complicate the therapy.

In total, three types of epilepsy are known - hereditary, acquired (arising due to traumatic brain injuries, inflammatory brain processes), uncaused (when a causal relationship has not been identified). Benign epilepsy does not occur in adult patients, it is a childhood disease that disappears with age even without medical intervention. However, some doctors consider epilepsy to be a chronic neurological disease with regularly recurring attacks and inevitable pathological consequences for brain structures.

In practice, there are often cases of the absence of a progressive (progressive) course of epilepsy, when, after a long absence of seizures, patients retain optimal mental abilities. All this testifies to the absence of an unambiguous answer to the question of the complete cure of epilepsy. Definitely, severe brain damage, epileptic childhood encephalopathy, meningoencephalitis are not cured.

The effectiveness of therapy can be influenced by such factors as the nature of the seizures in a particular patient, the age of the patient at whom the seizures manifested, and the intellectual level of the person. At the same time, an unfavorable prognosis for treatment will be in such cases when:

  • treatment begins late;
  • therapy is ignored when the patient is at home;
  • social circumstances not conducive to treatment;
  • individual characteristics of the patient.

Drug therapy

Medical products (preparations, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor's prescription. Recommended reading: " Why can't you take medications without a doctor's prescription?".In epilepsy, a persistent focus of excitation occurs in the human brain. Closely located neurons in large groups begin to actively generate an electrical potential, which then spreads to all other parts of the brain. To understand the function of antiepileptic drugs, it is important to know the mechanism of signaling from neuron to neuron. Electrical signals travel along nerve fibers. The current in such fibers is generated by the alternating opening and closing of ion channels on the cell surface. With the penetration of calcium and sodium cations into nerve cells through special channels and the countercurrent of potassium cations, charge differences arise in the region of neuronal membranes, which is a nerve signal that will subsequently be transmitted along the nerve fiber. When an electric charge reaches the nerve fibers, neurotransmitters are released from them with the help of synaptic clefts - special substances that will transmit signals to other neurons. Neurotransmitters excite cells (glutamate, for example) or decrease their activity (gamma-aminobutyric acid).

Antiepileptic drugs can affect all of the above steps by normalizing neuronal activity. All of them can be grouped according to the mechanism of action on:

  1. Sodium channel blockers, among which Lamotrigine and Carbamazepine stand out. Lamotrigine blocks the release of glutamate and prevents the already circulating neurotransmitter from causing electrical signals in cells. Carbamazepine will block sodium channels on the surface of neurons, which will prevent signals from passing on.
  2. ​​
  3. Drugs that affect gamma-aminobutyric acid, which include Phenobarbital and Diazepam (tranquilizers), which cause high sensitivity of gamma-aminobutyric acid receptors and thus have a sedative effect.
  4. Calcium channel blockers, such as Ethosuximide, which interferes with the propagation of signals along the nerve fibers.
  5. Modulators of synaptic vesicles of protein 2A - Levetiracetam, which enhances the effect of neurotransmitters that reduce the excitation of neurons. The drug has a complex effect on the brain.
  6. Multiple acting agents, which include Topiramate and Valproic acid. Topiramate increases the inhibitory properties of gamma-aminobutyric acid in the region of nerve cells. Valproic acid is used to increase the amount of gamma-aminobutyric acid in the central nervous system, but it can also presumably have a complex effect.

All drugs can be divided into basic or traditional and new, which specialists have received relatively recently. Traditional drugs have been studied in more depth, and new ones have great potential for impact, but so far in the future. To date, new developments are used in addition to the main therapy with traditional means.

Antiepileptic drugs are one of the treatments for epilepsy. Medicines are available in tablets, capsules, granules for oral administration. Their effects may be immediate or sustained release. Immediate preparations very quickly provoke an increase in the concentration of active components in the blood and their equally rapid decline, which leads to an increased effect at the start of entering the human body and a sharp decrease in exposure after reaching the peak of any drugs. Each subsequent decrease in the concentration of the agent provokes a weaker effect on the nervous system.

Sustained release formulations have multiple layers of active ingredients that are placed on a base. When the tablet preparation is dissolved, more and more portions of the substances needed for treatment are gradually released. This leads to maintaining a constant concentration of the drug in the blood for a long time, reducing the frequency of taking medications. Such treatment is much more convenient for patients to use at home, which increases adherence to therapeutic prescriptions. Also, sustained-release drugs help to better control the pathology, since when they are taken, there are no peaks in the concentration of the drug and its fall. With a similar effect, in addition to tablets, there are also granules that are soluble in semi-liquid or liquid food, which can be used for children or in patients with difficulty swallowing.

In addition to granules and tablets, drugs for the treatment of epilepsy can also be produced in the form of drops, syrups and injections. Such forms can be used for the treatment of pathology in childhood, as well as for the rapid relief of seizures or their series.

Common anticonvulsants in the treatment of epilepsy, in addition to those already mentioned, include:

  • Clonazepam;
  • Phenytoin;
  • Beclamid;
  • Benzobarbital;
  • Valproate.

These drugs help to stop seizures in various forms of epilepsy - temporal, focal, cryptogenic, idiopathic. Before using any drug, it is important to consider all possible complications from their use, since each drug can provoke severe side effects.

The greatest efforts in modern medicine are made for the treatment of epilepsy with relapses. Patients in this case are forced to take medications for many years, which causes addiction to drugs. This state of affairs helps the pathology to function despite treatment.

Correct treatment of epilepsy involves the correct dosage of drugs that maintains the pathology within the required limits. Therapy can last for each patient a different amount of time. Its duration is directly affected by the frequency and duration of periods of remission. With outpatient observation of a patient, it will be much easier for a doctor to prescribe the necessary dosage of funds.

When prescribing antiepileptic therapy, one drug is always used, since their combination can lead to the accumulation of toxic substances. The above drugs are first-line drugs when prescribed. These are the most studied preparations both regarding the therapeutic effect and the side effects produced.

There are also second line drugs:

  • Topamax;
  • Sabril;
  • Lamictal;
  • Neurotin.

Such drugs are not very popular due to their lack of study, or because of severe side effects. However, sometimes doctors choose them based on the individual clinical pictures of patients and the forms of seizures.

Surgery

When drug therapy for epilepsy fails, doctors sometimes use neurosurgery, that is, they perform surgery on the patient's brain. The development of seizures in epilepsy is always provoked by excessive activity of some part of the brain, called the epileptogenic focus. After excitation of the epileptogenic focus, activity can spread to other brain regions, and the patient begins to have an attack. In this case, the goal of surgical intervention will always be to limit the spread of excitation from the identified focus or to eliminate it together with part of the patient's brain.

The spread of such excitation can be limited by making incisions along the surface of the brain or by dissecting the corpus callosum, which is an array of fibers that serve as a connecting structure between the cerebral hemispheres. Dissection of the corpus callosum will block the passage of excitation from one hemisphere of the brain to another, which will help to avoid attacks in the future. Superficial incisions along the cortex block the path of excitation to other parts of the brain, and its partial removal helps to eliminate the source of the attack.

Precise localization of lesions is very important before surgery. Neurosurgery for epilepsy is used without reference to the age of patients, but it is not effective for every form of the disease or type of seizure. Also, any operation may have complications of an irreversible nature with neurological disorders (for example, the patient may remain paralyzed).

In case of focal type of epilepsy provoked by neoplasms of the brain or an aneurysm, surgical treatment is indicated for the patient. Operations are most often performed without the use of general anesthesia in order to be able to monitor the patient's condition and prevent damage to the most important brain areas that are responsible for the functions of movement, thinking, and speech. Therefore, during surgery on the brain for epilepsy, local anesthesia is used.

Operations are also highly effective in the temporal form of the disease. The temporal lobe of the brain is either resected or the hippocampus with the amygdala is selectively removed. The second in this case is much better for the patient, and more than 90% of such operations end with the person never having seizures again.

In case of underdevelopment of the cerebral hemisphere or hemiplegia in children, such a hemisphere is completely removed by hemispherectomy. In primary idiopathic epilepsy, a callosotomy is indicated, aimed at interrupting the connections between the cerebral hemispheres and, accordingly, at getting rid of seizures.

Neurostimulation of the brain

When an epileptogenic focus is found in a certain area of ​​the brain without movement, neurosurgery can be used. For pharmacoresistant epilepsy, this method is not suitable due to the multiplicity of constantly wandering lesions. In this case, doctors use the technique of neurostimulation of the vagus nerves.

The vagus nerves help the brain control the work of the internal organs of the abdominal and chest cavity - the heart, lungs, stomach, part of the intestines. The nerve is paired, descends to the left and right along the neck down from the brain. It is necessary to act on the vagus nerve on an ongoing basis with the help of special equipment similar to a pacemaker. Stimulation electrodes are attached to the left nerve and the pulse generator is placed subcutaneously. After implantation, the patient turns to the doctor to adjust the pulse frequency and monitor the status of the device.

Vagus nerve stimulation has been used in the treatment of drug-resistant epilepsy for decades, but the exact mechanism of the effect of such treatment is not yet fully understood. However, clinical evidence supports the benefit of this technique in pediatric and adult patients whose epilepsy is resistant to medical treatment. Also, neurostimulation can be used in combination with drug therapy if the latter is not effective enough or if surgical intervention is ineffective or impossible.

Laser therapy for treatment

Sometimes magnetic laser therapy can be used to completely get rid of seizures. Laser therapy greatly facilitates the course of the disease in patients undergoing a full therapeutic course. The duration of laser therapy is usually about 1.5 years. It includes 3 main schemes of laser exposure, which are performed in a certain sequence and at established time intervals.

Laser therapy is carried out using devices that can produce magnetic light waves. The use of a laser allows:

  • to increase the restorative (adaptogenic) activity of the patient's body, increasing the stability of impaired brain structures;
  • rebuild the bioelectrical brain activity;
  • activate the process of synthesizing RNA and DNA;
  • normalize brain rhythm;
  • improve metabolic processes in the area of ​​the cerebral cortex.

Laser therapy, used for years, has shown significant benefits compared to standard medical therapy. Among them:

  • the compactness of the hardware unit for the technique, which is easy to move, which allows you to perform procedures at home, when moving patients in cars, etc.;
  • the use of laser therapy does not involve the withdrawal of medical treatment, which can be gradually reduced to nothing after several laser courses;
  • magnetic laser treatment allows minimizing the dosage of drugs, and in mild forms of pathology, completely eliminating them;
  • the therapy has no allergic, adverse or toxic reactions of the body;
  • significantly reduces the duration of treatment and the amount of medication used.

On the eve of the appointment of laser therapy, patients with epilepsy must undergo tomography and electroencephalography. After the course of treatment, the patient will be examined again to assess the effectiveness of laser therapy in a particular case.

The second method of laser treatment of epileptics is thermal ablation. The procedure is performed under the control of magnetic resonance imaging, on the eve of the application of the method, an examination is carried out to identify the exact dislocation of the foci.

The course of laser thermal ablation is a sequential drilling of a hole in the patient's skull, where the laser beam is focused, creating high temperatures that turn off convulsive foci from the functionality of brain activity.

Laser thermal ablation contributes to the effective therapy of patients whose lesions are located in hard-to-reach areas, as well as in the event of mental changes in the course of the disease. The recovery period after laser thermal ablation is short, it is necessary to take medication for a short time after the intervention.

In modern medicine, new developments are constantly being made for laser therapy for epileptics, so there is a possibility that in the near future laser therapy will completely eliminate seizures in patients.

Spa treatment

Spa treatment for epilepsy does not bring any results, so this diagnosis cannot serve as an indication for a trip to a sanatorium. However, with concomitant pathologies and mild forms of the underlying disease (if more than 3 months have passed since the last attack), you can go to a sanatorium if you exclude rehabilitation methods during treatment that can harm epilepsy.

Physiotherapeutic treatment (any electroprocedures), pharmacopuncture, acupuncture are contraindicated for epileptics. Balneotherapy can be prescribed to patients on an individual basis. To a greater extent, spa treatment for patients with epilepsy is a way to relax, travel, which has a positive effect on the course of the disease and does not lead to provoking seizures.

How to stop an attack at home

What to do with an attack in a dream

Sometimes epileptic seizures are associated with sleep, occur either when falling asleep, or when waking up, or during a night's sleep. This leads to a particular helplessness of the patient, since at such a time he is usually alone in the room, which often leads to injuries, injuries from furniture corners or other dangerous household items. Therefore, in order to protect a person in case of possible night attacks, it is necessary to provide him with a bed with a soft headboard to prevent bruises, always remove any sharp objects located near the patient's bed, provide the patient with a lower bed in height to minimize problems with a possible fall from it, and next to the bed lay a soft thick carpet to absorb shock, equip the bed with only 1 pillow and, if possible, do not leave the patient alone at night.

Seizure after alcohol

Some people are able to prevent alcohol seizures at home. This can be achieved if you subtly notice the precursors of the disease. At the onset of an alcoholic attack, loss of consciousness and convulsions that have arisen, first aid should be given to the patient. First, the patient should be safely laid in a comfortable position where there are no hard or sharp objects nearby that can be hit or hurt. The head is placed on a pillow, and the body itself is placed on its side to prevent vomit from entering the respiratory tract or swallowing the tongue during an attack. If asphyxia (sagging of the tongue) has already occurred, it is necessary to press on the lower jaw from both sides, open the mouth, remove and fix the tongue.

If the seizures last more than a couple of minutes, an ambulance should be called urgently. If the convulsions last more than 30 minutes, this indicates the occurrence of status epilepticus, which requires long-term complex therapy in a hospital.

Alcoholic epilepsy can be treated both in the hospital and at home, depending on the severity of the pathology. All therapy should be aimed at eliminating the cause, including medication, psychotherapeutic treatment and diet therapy. All this will prevent the occurrence of new seizures.

Controlling seizures in a child

For those who are present during an epileptic seizure, it is very important not to get lost and know how to stop it. This is especially important if the attack occurred in a child who is unable to independently deal with the precursors of the condition. The most important thing for those around you is to be calm. It is required to lay the baby on its side, place a soft pillow under the head. It is not worth moving the child all the time, you should immediately take care that there are no dangerous objects around the place where he lies. The baby's head should always be on its side, in order to avoid asphyxia with the tongue or vomit. At the beginning of vomiting, it is worth turning the child's head more to the side. It is categorically impossible to unclench the baby's teeth and stick objects into his mouth, just as it is impossible to water or feed the child. If a child's attack lasts more than 5 minutes or there are constant repetitions of attacks, it is important to call an ambulance team in a timely manner. The child will also need medical intervention in case of injury during the attack.

Nothing else to do during an attack. It will either pass by itself, or it will be stopped by qualified doctors. It is only important to ensure the safety of the baby during an attack and the timely call of doctors.

Treatments for children

Depending on what causes childhood epilepsy, doctors prescribe different treatments. It is important not only to stop the attacks that occur in a timely manner, but also, if possible, to eliminate the cause of the disease. A huge number of modern anticonvulsants can help with all forms of epileptic seizures, it is only important to choose the right therapy in each case.

Anticonvulsant drugs are usually given to children who have had more than 2 seizures. Approximately 30% of all cases of drug therapy in children lead to a complete cure. If the form of pathology is severe, medications reduce the frequency and severity of seizures. Initially, the pediatric dosage of all drugs is very low. It is increased gradually to obtain a facilitating effect. Then therapy is already continued in the form that will completely eliminate the symptoms. However, it is important to remember that the treatment of epilepsy takes a long time, sometimes the child needs to be treated for months, and sometimes for years.

Consequences if left untreated

Once a diagnosis of epilepsy is made, the patient's therapy should be continued. In the absence of treatment in this case, various adverse consequences can occur. For example, patients with seizures can be seriously injured, seizures that occur can create problems in society - at work, in the family. Also, without adequate treatment, seizures will become more frequent and more pronounced, which invariably leads to the formation of status epilepticus, which is very difficult to recover and life-threatening.

If patients experience small, non-convulsive seizures at first, they may decide they can just endure it. However, if left untreated, they will soon turn into seizures, which will be more difficult to treat. Also, non-convulsive seizures can be evidence of severe brain pathologies. Untreated epilepsy significantly depresses the patient's cognitive functions.

Relief from recurrent seizures will lead to the restoration of normal life, reduce the risk of degradation of mental and intellectual abilities, so taking medication for this disease is extremely important.

Where to go for symptoms of epilepsy

Epilepsy specialists

In domestic clinics, patients with epilepsy are treated, in most cases, neurologists. Although in some large cities, as well as in clinics in many other countries, today there are already narrow specialists in this area - epileptologists, who study in depth the features of the functioning of pathology in the human body. Epileptologists are well versed in the types of epileptic seizures, how certain antiepileptic drugs affect the human brain, what are the physiological and genetic characteristics of the patient, in which he begins to suffer from one form or another of epilepsy. This approach helps to establish an accurate diagnosis and prescribe effective medication. That is why the effectiveness of the treatment of epilepsy in such cities, as well as foreign clinics, is many times higher.

A well-known European epileptologist is Professor Antonio Russi, who founded the Institute of Epilepsy in Barcelona in 1987. The doctor receives at this institute various patients with this pathology, adults, children, patients with very severe forms of the disease. On the basis of the Institute, a complete diagnosis is carried out, specialists can choose highly effective therapy. Professor Roussi is involved in scientific research concerning the accuracy of the definition of epileptic foci in the human brain and is President of the International Congress of Epilepsy.

Prof. Uri Kramer, Israel's leading pediatric epileptologist, heads the neurology department at the Ichilov Clinic and sees patients there. The scientific developments of this specialist include the EpiLert bracelet, which warns in advance about a possible seizure. The well-known adult epileptologist Professor Svetlana Kiperwasser also receives here.

Clinics in Russia and abroad

Several large centers were specially opened for patients with epilepsy in Russia. Clinics offer patients highly qualified treatment, consultations with epileptologists specializing in this disease. Any medical institution of a given profile will conduct a comprehensive differentiation of epilepsy from other neurological pathologies and select the best treatment of its kind. Epileptologists treat even the most severe cases of the disease, including those that do not respond to either medication or anticonvulsant therapy.

Epilepsy clinics serve children and pregnant women suffering from this pathology. Pediatric epileptologists are narrow-profile specialists with unique knowledge for the diagnosis and treatment of rare forms of the disease in the youngest children. Here, therapy will always be prescribed depending on the age of the patient and his unique features.

Clinics use all currently available diagnostic techniques. Here you can undergo an electroencephalogram, magnetic resonance imaging and other necessary procedures to clarify the diagnosis and form of pathology.

Among the most well-known Russian centers where patients with epilepsy can receive reliable care are the Institute of Child Neurology and Epilepsy, headed by Professor K. Yu. epilepsy), the Neuro-Med Medical Center (consultative and diagnostic assistance to patients with pathologies of the nervous system of all ages), the A. A. Kazaryan Center for Epileptology, the Scientific Center for Children's Health at the Russian Academy of Medical Sciences and many others.

If a patient has more than three different treatment regimens that have not been effective, the child is delayed in development for no apparent reason, or the patient suffers from constant seizures with all possible treatments, it is worth choosing a foreign clinic for the treatment of epilepsy. This pathology is most effectively treated in Germany, Spain, Israel, Turkey and South Korea.

Teknon Medical Complex in Barcelona is the leader in the effectiveness of therapy among patients of different ages. Here, effective treatment of epilepsy is carried out in 95% of cases. The main method of examination here is a four-day EEG monitoring, which allows specialists to select the most appropriate and effective means of treatment. During this diagnosis, a specialist can evaluate the reaction of the human body to a particular drug and choose the appropriate one. In addition to this, pharmacogenetic testing is carried out here, which determines not only the effectiveness, but also the patient's tolerance of various pharmacological agents. Only after that, a competent treatment regimen is selected, in which side effects are minimized.

The Sourasky Medical Center in Ichilov, Israel is the largest public hospital in the country. The symptomatology of epilepsy is cured here in 95% of all cases of the disease. Specialists from Ichilov carry out a comprehensive diagnosis of patients, choose individual treatment, monitor its progress and effectiveness. Even after the patient leaves the clinic, he can always contact the attending physicians and adjust the course of his own therapy with their help.

Sources
  1. World Health Organization (WHO). June 20, 2019. - Epilepsy.
  2. Official site of the Scientific Center of Neurology. April 27, 2018. - Treatment of epilepsy.
  3. epilepsyinfo.ru. – Drug treatment of epilepsy.