Experience in our neurology clinics is that half of
the epilepsy population in the United States, i.e. more than three million
Americans (similar percent of the global population afflicted with epilepsy)
can control their epilepsy. When the epilepsy is controlled with just the
initial trial of anticonvulsant drugs (ACD) the long term prognosis for that
person’s epilepsy is very good. We physicians start treatment with a commonly
used ACD that from experience has shown effectiveness at the commonly used dosage.
Side-effects such as drowsiness and laboratory tests of liver function, blood
counts, etc. hopefully won’t be significant and the patient will adapt to the
treatment quickly.
Edward Faught, MD, wrote on the reality and the hope
in treatment.1 As our patients are no doubt familiar, the
course of epilepsy is variable. Experience shows that not achieving good
control averages one-third of the epilepsy population, despite multiple
different ACD treatments at various dosages. Identifying the presence or
absence of brain lesions can still lead us astray as some patients do well
despite significant abnormalities on scans. Younger age at onset, abnormal EEGs
and very frequent seizures can adversely affect the prognosis.
According to the International League Against
Epilepsy, drug resistant epilepsy is suggested when 2 ACDs appropriate for
their type of epilepsy, as judged by your experienced neurologist, at tolerated
dosages fail, then a third drug probably will also fail to control all
seizures, too (10%).2 However, other studies suggest
hope. Schiller and Najjar noted that even after 2 to 5 ACDs had failed another
drug could possibly produce seizure control. That was found in 16% of those
patients deemed therapeutic failures.3
Keep in mind that a highly successful treatment that
can cure epilepsy is brain surgery. In highly selected patients studied to rule
out adverse side effects that would result from surgery, these procedures are
safe. Post surgery life can be normal. Refer to my previous surgery-related
blogs #155 (Successful surgery with robot assistant: https://lancefogan.blogspot.com/2017/12/blog-89-surgical-removal-of-seizure.html), # 145 (Epilepsy patient passes driving test after brain
surgery for poorly controlled epilepsy https://lancefogan.blogspot.com/2022/08/blog-145-epilepsy-patient-passes.html), #121 (…Epilepsy surgery is
safe. https://lancefogan.blogspot.com/2020/08/blog-121-if-your-seizures-arent.html).
In
conclusion we should keep in mind that there is always hope in epilepsy
therapy.
1.
Faught
E. Balancing reality with hope in epilepsy therapy. Neurology 2018;91:
p989-990.
2.
Kwan
P, Arzimanoglou A, Berg AT, et.al. Definition of Drug-Resistant Epilepsy Epilepsia
2010; 51: 1069-1077.
3.
Schiller
Y, Najjar Y. Quantifying the response to antiepileptic drugs: effect of past
treatment history. Neurology 2008; 70: 54-65.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.
