Management of Epilepsy

Approximately two-thirds of the patients with epilepsy would be controlled on seizure medications if appropriately managed. More than 20 medications are available to treat patients with seizures. The choice of drugs to treat seizures depends on whether the patient has focal or generalized epilepsy and on several other factors like the side effect profile, comorbidities, cost, and pharmacokinetics. The treatment duration is 6-12 months for acute symptomatic seizures and 2-3 years for controlled epilepsy, after which the patient is reassessed to tapering or continuing seizure medications. Women of childbearing age who are on seizure medications should be on folic acid to prevent neural tube defects in children. Also, polytherapy and Valproic acid should be avoided if possible. Approximately half the patients who do not respond to medications can be evaluated for epilepsy surgery to remove the area of seizure onset with surgical resection or laser therapy. The success rate of epilepsy surgery ranges from 30-80%. Neurostimulation (vagal nerve stimulator- VNS, Responsive neurostimulation- RNS, Deep brain stimulation- DBS) is available to treat refractory seizures in several countries. Epilepsy diets (ketogenic diet, low glycemic index diet, modified Atkin’s diet) are based on the principle that ketone bodies generated by low glucose, high protein, high-fat diet decrease seizures similar to seizure medications. 'Effective management of epilepsy also includes appropriate investigations (EEG, MRI brain/ CT head), management of medication side effects including teratogenicity, andaddressing psychosocial features like depression and social stigma'.