How to Manage an Epilepsy Diagnosis

Receiving a diagnosis of epilepsy presents significant challenges for you and your family. It’s natural to have questions about the frequency of seizures and the associated risks, and it’s important to seek clarity and understanding in this journey.

Fortunately, most patients can be diagnosed with epilepsy through a neurologic evaluation or a referral to an epilepsy center for more complex cases. With appropriate antiseizure medications and lifestyle adjustments, 60 to 70% of patients can achieve seizure freedom once treatment begins.

“It’s important to understand that seizures can be managed in most cases, and people can lead normal, productive lives,” says Andres M. Kanner, M.D., director of the Comprehensive Epilepsy Center at the University of Miami Health System. “Contrary to popular beliefs, epilepsy is not associated with declined cognitive function, and women can have healthy babies if they choose to do so.”

Epilepsy can present with different types of seizures, which define the type of epilepsy.

The type of seizure, in turn, is determined by the specific area of the brain that is impacted, and the type of abnormal electrical activity that occurs there.

“I explain to my patients that the brain is like a computer,” says Dr. Kanner. “Sometimes, excessive abnormal electrical activity or a short circuit causes the computer to freeze or crash, after which it must reboot. That’s what happens during a seizure — too much electrical current in specific circuits of the brain causes brain structures to malfunction, after which it takes some time for these structures to start working again. A proper diagnosis of the type of seizures and the type of epilepsy is essential to establishing the appropriate treatment.” 

How is epilepsy treated?

The initial treatment of epilepsy consists of the use of antiseizure medications, which can result in their remission in 60 – 70% of patients. Today, there are 32 antiseizure medications in the market, but not all medications are universally effective. Several variables are considered in the selection of the ideal medication, including the seizure and epilepsy type and the patient’s gender, as some medications can have a negative impact on pregnancies. Providers will also consider other medical, neurologic or psychiatric disorders that are present in the patient, as certain antiseizure medications can have a negative or positive impact on these conditions. Finding the right treatment for your individual case takes a proper diagnosis and good collaboration between the patients, their family, and their health care providers.

Once the appropriate medication regimen has been selected, it’s critically important to take them as directed.

Missed doses of medications can result in breakthrough seizures.

“Epilepsy can have a major impact on patients’ lives and can affect their livelihood, particularly if patients have to stop driving, have to modify their jobs or make other changes,” says Kanner. “That’s why making the right diagnosis and following the proper medication regimen is critical in this process.”

Keep the lines of communication open with your provider in the case of seizure recurrence.

“You don’t need to go to the doctor for every seizure, unless they get more severe or frequent,” says Dr. Kanner. “But you should notify your doctor via phone if a seizure does occur, so that we can adjust your medication accordingly if needed.”

If you have been treated with two to three antiseizure medications that are appropriate for your type of epilepsy at optimal doses, and you continue to have seizures, medication may not be the ideal treatment for you. In this case, you should be evaluated to establish if other type of treatments like epilepsy surgery may be an option to cure your epilepsy.

Dr. Kanner says that between 50 – 70% of people treated with surgery can become seizure-free.

“Evaluation in an epilepsy center like the one at the University of Miami is important to ensure that you receive the proper treatment,” he says.

Some simple lifestyle strategies can also help reduce the risks associated with epilepsy.

Avoid risky behaviors if your seizures are not under control. These include what may seem like regular tasks, such as driving, climbing on ladders, taking a bath, or lifting free weights.

Also:

• Get enough sleep
• Limiting alcohol intake
• For some, a ketogenic diet or modified Atkins diet, which feature low carbohydrate, high fat, and moderate protein intake, have been helpful. These are typically used for children with uncontrolled seizures, but they may be helpful for others as well.

Remember, you are not alone. Let others help.

People who you or your loved one interact with on a daily basis need to be aware of your condition and the potential risks involved. If you have a child with epilepsy at school, you should have an action plan that you work out with your health care providers and share with the school. This should involve guidance on what to do if a seizure occurs and the availability of rescue medication that is shared with the school nurse. If you’re an adult with epilepsy, you may want to share similar information with your coworkers, so they’ll know how to react in the event of a seizure.

“Education is important for the family and for others who they interact with,” says Dr. Kanner. “This not only enhances the safety of the person with epilepsy, but it can reduce some of the stigma around the disease, as well. There’s a lot of fear that comes from those who witness seizures, so educating them on what they have to do helps to empower them and provide them with the confidence to assist the person having the seizure.”

Written by Wyatt Myers, a contributor for UHealth’s news service.

Tags: Dr. Andres Kanner, epileptic seizures, generalized epilepsy, neurology care in Miami, parts of the brain, seizures start