Seizures are the manifestation of uncontrolled electrical activity in the brain. Affected individuals show clinical symptoms of seizures with twitching or jerking of one side or their entire body. With this they can make gasping noises, turn blue in the face, bite their tongue or lose control of their bladder. These symptoms are charateristic of a grand mal seizure. During an epileptic attacks, the person is not responsive or aware of what is going on around them. Fortunately there is excellent treatment available to control seizures and in many cases, keep patients seizure free.
It is estimated that there are 2-3 million individuals in the United States who suffer from recurrent seizures (epilepsy.) Many of these people are neurologically intact with the cause of their seizures being unknown. It is estimated that up to 10 percent of the population will suffer a single seizure in their life time. This does not mean that they will go on to have recurrent seizures or epilepsy. The average lifetime risk of having recurrent seizures is 3 percent.
Risk of developing seizures include prior head injuries, alcohol or drug abuse, stroke, meningitis or other brain infections. Brain damage from trauma, surgery or tumors can also predispose to seizures. For anyone who has even a single seizure, they should see a neurologist for a complete evaluation. A minimum of screening lab work, an EEG (electroencephalogram) and MRI brain scan should be done. Of course a complete history and physical (neurological) exam is also required. One important point to remember is that a normal EEG does not exclude the possibility that a patient suffers from seizures. In fact, approximately 70 percent of patients with recurrent seizures will have a normal EEG at all times other than during the time when they are having a seizure.
Fortunately there are several excellent seizure preventing medications (anticonvulsants) available. For decades, Dilantin, Tegretol and Depakote were the mainstay in seizure treatment. In the 1990s, several new anticonvulsants received FDA approval. These included Felbatol, Topamax, Lamictal, Neurontin, Keppra and Zonegran. In 2005, the FDA approved Lyrica for treatment of seizures. Although highly effective in controlling and stopping seizures, the newer anticonvulsants are overall no more effective than the older agents. One benefit of the newer agents is that they do not require as much lab monitoring as the older agents. Some anticonvulsants, such as Lamictal, Neurontin and Lyrica require no lab monitoring.
In summary, patient with recurrent seizures (epilepsy) or for those that have had a single seizure but are at high risk for further seizures, there are a number of therapeutic options available to control their seizures and improve their quality of life. Many patients can have complete control of their seizures, meaning seizure free, with appropriate evaluation and treatment. Most neurologically intact individuals can lead normal lives with specific seizure care by a neurologist. This fact has been shown through many studies on seizures and is the foundation of evidence based medicine for seizure control. It is critical that they see a neurologist as soon as possible, after their first attack, so that proper evaluation and treatment can be started.
Posted in Seizures, Stroke and tagged Depakote, Dilantin, drug abuse, EEG, epilepsy, evidence based medicine, FDA approval, grand mal seizure, Keppra, Lamictal, lifestyle, Lyrica, neurologist, Neurontin, Quality of Life, seizure, Seizures, Stroke, Tegretol, Topamax, Zonegran by Dan Kassicieh, D.O.