Blog # 169: Balancing Reality with Hope in Epilepsy Treatment

 

 

 

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.