Treatment of epilepsy in adults and children
Treatment of epilepsy is a serious and heavy task, the principles of which remain unchanged for many years: the earlier the onset, individual approach, the continuity and duration of therapy. The goal of treatment in epilepsy is not an attack and not even the disease and improving the quality of human life. In any case it is impossible to achieve elimination of seizures at any cost, as the side effects from antiepileptic drugs (AED) may at times exceed the benefits.
The main method of treatment of epilepsy in both adults and in children is conservative therapy by regular admission special anticonvulsive drugs. Today it is known and used in the practice of more than a dozen such medications. They are all highly potent drugs, and issued strictly on prescription. Each of them has its contraindications and side effects that must be taken into account in the preparation of the treatment program.
Video transmission about epilepsy:
Indications for conservative treatment of epilepsy
Consider the basic principles according to which doctors prescribe continuous antiepileptic therapy, as well as cases where anticonvulsants are not assigned.
So, do not require the appointment of specific pharmacotherapy after a first epileptic seizure in the event of:
- if the patient is a child and he has no risk factors for further development and progression of epilepsy;
- if the seizure happened with a pregnant woman, the pregnancy is uncomplicated and no risk factors for recurrence of attack;
- if the seizure is symptomatic in the background of some other acute disease;
- if the seizures developed in connection with long-term lack of sleep.
A situation where the selection of a specific antiepileptic treatment after a first seizure must:
- the debut of the disease with epileptic status;
- if the doctor is confident that the patient has started idiopathic, not symptomatic, generalized epilepsy;
- if a man has a neurological disease that causes seizures;
- if the results of the EEG recorded epileptic brain activity;
- in anamnesis there is birth injury or other organic pathology of the brain;
- if the family already there are cases of epilepsy;
- if there are specific epileptic mental changes.
Principles of pharmacotherapy of epilepsy
The choice of medication, dose and regimen depend on the following factors:
- type of epileptic seizures;
- the age and gender of the patient;
- the presence of concomitant diseases;
- social and economic conditions of human lifeand opportunities;
- individual characteristics of the patient;
- the presence of contraindications to a particular drug.
Treatment of epileptic seizures always start with monotherapy (1 drug use), while using drugs from selection groups depending on the type of seizures. The effectiveness of this treatment was assessed after 3 months of regular intake. Only after this time you can make a conclusion about the effectiveness of the selected medication, as well as to make correction of therapy. If you do it early, we can cause the development of pharmacological resistance.
If after 3 months of regular use the effectiveness of drugs is small, then prescribed another drug from the group of choice as monotherapy.
If after 3 months of taking other anti-epileptic means the seizures continue, we administered combination therapy of 2 antiepileptic drugs. The ineffectiveness of such combinations continue the search for drugs that will eliminate the seizures. In this alternative include the group of drugs. If all options are tried, we administered 3 of AEP. The use of more than 3 drugs is not used, as it is considered inappropriate and dangerous for the patient.
If we turn to statistics, 20-30% of patients with epilepsy despite adequate selection of medical treatment, are not sensitive to conservative treatment, which requires the use of more radical methods for example surgical treatment.
Treatment of epilepsy should be long-term, consistent and continuous to achieve success. Patients should follow the dosage of drugs and duration of their admission. In no case should not miss the medication, even if no seizures for quite some time. Because any violation of the regimen of drugs can lead to secondary unresponsiveness of the patient to pharmacological treatment and disease progression.
Drug treatment purposes:
- To save the patient from pain during the period of the attack.
- To prevent the development of new seizures.
- To reduce the frequency of epiperipatus if you achieve them a complete cessation impossible.
- To reduce the duration of attacks.
- To minimize the risk of side effects of therapy.
- To ensure the safety of others.
The main antiepileptic drugs
Consider antiepileptic drugs of the first line.
This drug is a choice in the case of partial seizures with any form of epilepsy. It can not be used when absence seizures and myoclonic convulsions. In addition to anticonvulsant abilities has psychotropicaction. The dose in adults is 500-1600 mg per day is 2-3 times of the reception.
Common side effects of carbamazepine:
- drowsiness, impaired balance,
Stages antiepileptic treatment
There are 3 stages of treatment of epilepsy in adults and children.
The selection of the drug and dosage regime
Is appropriate selection of drug or drugs to treat various types of seizures based on individual patient characteristics and age. You need to consider doses to children, adults, and the elderly. Unfortunately, 20-30% of patients cannot find a therapy that would control the course of disease. In this case we talk about primary resistant form of epilepsy. If the effectiveness of medicines has declined after their initial good effect due to non-compliance by the patient dosing regimen, it is referred to as secondary resistance.
This is a very important step in the treatment of epilepsy, which is often difficult to comply with. No seizures for 2-3 years enters the patient, his family, and sometimes the doctor astray. Drug dosages are reduced or they are cancelled altogether. But this does not mean that the disease has receded, and in case of violation of dosage of the medication, the seizures are developing again.
The gradual abolition of AEP
Normally start the treatment for epilepsy begin after 3 years of stable remission. Children who are in puberty, to cancel drug therapy should not even after remission for 3 years, as this period itself is characterized by increased epileptic readiness. The dose of medication is withdrawn gradually. If the patient was taking several medications, they cancel one by one. The risk of recurrence occurs in 15-25% of cases after cancellation for 5 years.
Surgical treatment of epilepsy
Resorted to surgery in case of:
- epilepsy resistance to drug therapy, when multiple seizures, significantly impair quality of life;
- when treatment with medicines is effective, but the patient cannot tolerate the side effects from therapy;
- when the results of additional study demonstrated that seizures occur in a small and clearly limited areas of the brain that can be removed.
Do not use surgical treatment for primary generalized epiperipatus with loss of consciousness.
Video transmission on surgical treatment of epilepsy:
To eliminate seizures used neurosurgical removal of the pathological focus in the brain. This is particularly effective in the case when the symptoms are caused by cyst or tumor of the brain. Also used different variants of resection – lobectomy,hippocampectomy, callosotomy, hemispherotomy. It is very heavy and incapacitating interference, which are used only in extreme cases, for example, in this form of epilepsy, such as encephalitis of Rasmussen.