"There are many effective medications available now, and we try to choose one with few or desirable side-effects."
By:Lorraine Seabrook
Last week, we heard from a patient of Dr. Carran who has lived with temporal lobe epilepsy since her teenage years.
The patient describes what happened as she entered middle age:
"By the early 1980s my seizures were interfering with my ability to work and I replaced denial with action. An examination of my brain showed a small lesion on the temporal lobe. Because of the lesion’s location, surgery was not a good option. My doctor prescribed anti-seizure medication which greatly controlled my seizures and eliminated any more generalized seizures, although I still did and do have partial seizures," the patient states.
"Although I cannot predict when a seizure will occur, I do know that I continue to function through the seizure. For example, if I am holding something in my hand or typing at my keyboard when a seizure begins, I am still holding the object or typing after the seizure ends."
Dr. Carran explains "this patient’s seizures are caused by damage to the tip and inside of the temporal lobes in an area which supplies memory, the hippocampus. The damage here is called ‘mesial temporal sclerosis’ and is not a tumor or a mass, but a kind of scar that often occurs after head trauma, birth injury or encephalitis. This area can be removed easily to stop the seizures, but the patient is then at risk for increased memory problems, so it has to be considered carefully.
"The patient also has to continue taking medications since a new scar is created by the surgery. We try very hard to find the right medication therapy to stop seizures completely, before resorting to temporal lobectomy surgery, but sometimes (10-20 percent) it is the best chance for seizure freedom. If the seizures come from a different region of the brain than the temporal lobe, then surgery is much less effective."
Fortunately, new medications offer much hope to patients with epilepsy.
Dr. Carran notes that "there are many effective medications available now, and we try to choose one with few or desirable side-effects. For instance, for people who are very drowsy or who feel slow when they take older medications, we can try medications which are more activating. These can also help if someone is depressed, and some of the drugs have been shown to be good antidepressants or effective for other mood problems such as mania, apart from epilepsy needs.
"For patients who have diabetes and epilepsy, for instance, we can use medications which cause weight loss, thus improving both conditions. Likewise, for patients who have pain or headaches, we can choose a medication which reduces pain and treats the seizures as well."
The patient is quick to point out the difference the right medication can make in daily living.
"As I aged, I began to see that I was suffering lapses in my memory, a common side effect of having temporal lobe epilepsy. This frightened me because my mother has Alzheimer’s. In response to my concerns, my doctor has prescribed a new medication that not only controls my seizures but sharpens my concentration," the patient states.
"I still experience partial seizures approximately every three months and they are accompanied by an aura that fills me with fearful feelings, but my seizures last just seconds and I do not lose awareness. Through excellent medical care and a new generation of medications, I find that I am able to live and work with my condition and I view it as a fascinating disruption of the mind."
Dr. Carran points out that given the right circumstances, anyone can have a seizure. It is known that each of us has an inherited brain seizure threshold, making some people more resistant to factors known to invite seizures. People who have had more than one seizure need to be assessed for epilepsy. Fortunately, the majority of patients with epilepsy function normally between seizures and there are options available to help severely limit or eliminate seizures.
If you are with someone who has a non-convulsive seizure, keep the following first-aid basics in mind, as described by the Epilepsy Foundation:
• Watch the person carefully and explain to others what is happening, assuring them this behavior is not related to drugs or alcohol.
• Speak quietly and calmly without seeming angry or agitated.
• Guide the person gently away from any danger, such as a steep flight of steps, a busy highway or a hot stove. Don’t grab hold, however, unless some immediate danger threatens. People having this kind of seizure are on "automatic pilot" and instinct may make them struggle or lash out at the person who is trying to hold them.
• Stay with the person until full consciousness returns. If the seizure lasts for more that 4-5 minutes, call the emergency paramedics, or if there are 2 or more seizures in a row, without full recovery between them, the person should be taken to the hospital.
If this is a first seizure, the person should be seen immediately in the emergency room.
Melissa Carran, MD, assistant professor of neurology at Robert Wood Johnson Medical School, is a board-certified neurologist who serves as the medical director for The Epilepsy Center at University Medical Center at Princeton.