Medical practice is based as much on
your doctor’s experience as it is guesswork. You probably have already come to
this conclusion. Teamwork―the collaboration between
you (the patient), and your epilepsy-treating physician—is how many decisions are
made about whether treatment should be started and, if so, when? Other
considerations include the kind of treatment you should receive, how to adjust
treatment, and when to stop it?
Treatment options will vary
from patient to patient. Variables to consider include: age, gender, pregnancy
considerations, allergies, other illnesses and conditions, and whether the
patient needs to drive. For example, a middle-aged person who has had epilepsy
since his or her teens has suffered a seizure only when antiepileptic drug
blood levels became low and now has been seizure-free for eight years despite
occasional low drug blood levels can the anti-seizure medication(s) be stopped?
This is a reasonable question: we should not take any medication that’s not
indicated. What if the brain scan and EEG are normal? Would this mean the
person will remain seizure-free once the medication is stopped? Are the drug
levels, despite being low, still protective for that person and if the
medication is stopped will seizures recur? It is common for the EEG to be
normal in epilepsy. This occurs in up to half of patients
because
epileptiform activity may not happen during the 60-90 minutes of recording in
the EEG laboratory. So, normal EEGs do not discount an epilepsy diagnosis.
Consequently, the diagnosis of epilepsy is a clinical one, based on the history
of what happens to the patient and not based on any laboratory test.
Not enough data is available to
accurately counsel patients about when and if antiepilepsy medications can
safely be discontinued. If a patient
wants to taper off medications after being seizure-free for many years, and the
EEG is normal, the advice we can give our patient is, at best, really only
guesswork.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David
Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a
mother’s dramatic story that teaches
epilepsy, now available in eBook, audiobook and soft cover editions.
