Treating epilepsy involves customized care and dedication

Contributing columnistNovember 29, 2013 

LEE P. THOMAS

Epilepsy is a neurological disorder that causes people to have recurrent seizures. Unlike many diseases, epilepsy doesn't have a single specific cause. Rather, it can be caused by a number of factors ranging from lesions in the brain, stroke, metabolic abnormalities, genetic inheritance or infections of the central nervous system.

The incidence of epilepsy has two peaks — affecting either the young or the old. It is however predominantly a disease of childhood. Epilepsy affects more than 3 million people in the United States — just under 1 percent of the population. About 10 percent of the population is likely to have a single seizure by the age of 80. The annual cost of epilepsy is roughly $18 billion.

Seizures can have a dramatic impact on one's quality of life. For many young people with epilepsy, there is a level of social embarrassment, especially since seizures can lead to incontinence.

Adults with epilepsy may struggle to maintain a job because of recurrent seizures. If their seizures are not controlled, they are restricted from certain jobs such as those that involve handling heavy machinery or construction. They are also often reliant on others for transportation because of restrictions on driving.

Research has shown a relationship between epilepsy and depression. When the epilepsy is treated successfully, however, the depression symptoms lessen significantly.

Epilepsy has varying causes, and we do not have a medication that can reverse the condition. Instead the focus is most often on treating the symptoms: eliminating recurring seizures. Medication is the most common, and, generally, the most effective way to stop seizures and help those with epilepsy live normal lives.

One major drawback to the treatment options now available is that patients must live with the side effects of medication. These can include memory issues, cognitive problems, behavioral changes, sleepiness, tiredness, dizziness, unsteadiness, visual symptoms, nausea and vomiting. For many patients, however, living with minor symptoms is often worth the trade off of not living with recurrent, life-disrupting seizures.

The aim is always to find the most effective medication with the least possible side effects, allowing patients to lead normal lives and engage in regular activities.

When medications fail to control seizures, surgery may be the most effective way to treat epilepsy. Surgery is the most underused, yet the most rewarding treatment for epilepsy. For those whose epilepsy is caused by certain conditions — such as lesions in the brain, brain tumors and scar tissue — removing the area of the brain through resective surgery can eliminate seizures, leaving 60 to 90 percent of well-selected candidates seizure-free, depending on the cause.

Of course, this requires careful and extensive evaluation to ensure that surgery is the proper option and would not compromise other brain functions.

Some cases of epilepsy are more difficult to treat than others, but as physicians, we never give up. In treating this disorder, there is never a moment where I would say "I can't help you anymore."

Whether it's exploring surgery, finding a new medication or a combination of medications, or non-medical treatments like vagus nerve stimulation, there is always another angle to pursue when treating epilepsy, helping those with the disease live more well-adjusted lives.

Dr. Toufic Fakhoury is director of the epilepsy center at Saint Joseph Hospital, part KentuckyOne Health.

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