Managing Epilepsy: Insights and Treatment Options for Patients

Epilepsy?

I have been taking medication since I was three years old (both traditional Chinese medicine and Western medicine) and have visited countless hospitals.
At that time, Western medicine diagnosed me with "rheumatic arthritis" (which has since improved, but I still have kidney issues and epilepsy).
In my teenage years, I discovered blood in my urine, which indicated that my kidneys were not functioning well (I started dialysis in mid-April of this year).
It was also around that time (in my teens) that I learned I had epilepsy.
I have been on steroids from the age of three until I was 27 (early 1999).
My seizures involve full-body convulsions (during which I am unconscious) lasting about half a minute (according to bystanders).
Previously, the seizures occurred irregularly (sometimes once every few months, and other times two to three times a day).
Recently, however, they have averaged once a week (sometimes every two to three days).
If I increase the dosage of my anti-epileptic medication, I experience dizziness (unable to stand and objects appear to move up and down) and vomiting, so I reverted to the previous dosage.
The medications I am currently taking are: 1.
Tegretol 200mg, taken three times a day (1.5 tablets each time) and 2.
Originally Clobazam (Fresium), but since November 3, I switched to Rivotril 2mg, which I take one tablet at bedtime.
Dr.
Huang, how should I manage my epilepsy?

A-Lin, 20~29 year old female. Ask Date: 2000/11/15

Dr. Huang Yingzhe reply Neurology

If the dosage of Rivotril is gradually increased and still fails to control the condition, consider using other new medications such as Lamictal or Sabril.
Additionally, why has the frequency of seizures increased recently? Please discuss this with your physician!

Reply Date: 2000/11/15

More Info

Managing epilepsy effectively requires a comprehensive approach that includes proper diagnosis, medication management, lifestyle adjustments, and potentially exploring advanced treatment options. Given your history of epilepsy, renal issues, and the complexity of your medication regimen, it is crucial to work closely with a neurologist who specializes in epilepsy. Here are some insights and treatment options that may be beneficial for you.

Understanding Your Condition
Epilepsy is a neurological disorder characterized by recurrent seizures, which can vary in type and severity. Your description of generalized tonic-clonic seizures (previously referred to as grand mal seizures) indicates that you experience loss of consciousness and muscle contractions. The frequency of your seizures has increased recently, which can be concerning and may require a reassessment of your treatment plan.

Medication Management
You are currently taking Tegretol (Carbamazepine) and Rivotril (Clonazepam). Tegretol is a common antiepileptic drug (AED) used to control seizures, while Rivotril is a benzodiazepine that can help with seizure control and anxiety. However, both medications can have side effects, including dizziness, nausea, and cognitive impairment, which you have experienced.
1. Dosage Adjustment: It may be necessary to adjust the dosages of your medications. Since increasing the Tegretol dose leads to adverse effects, your neurologist might consider alternative medications or adjunct therapies that have fewer side effects.
2. Alternative Medications: There are several other AEDs available, such as Lamotrigine, Levetiracetam, or Valproate, which might be effective for your type of seizures and could be better tolerated. Discussing these options with your neurologist is essential.

3. Regular Monitoring: Regular follow-ups and blood tests are crucial to monitor the effectiveness of your medication and to check for any potential side effects, especially considering your renal condition.

Lifestyle Modifications
In addition to medication, lifestyle changes can significantly impact seizure management:
1. Sleep Hygiene: Ensure you get adequate and regular sleep, as sleep deprivation can trigger seizures.

2. Stress Management: Stress is a known trigger for seizures. Techniques such as mindfulness, yoga, or cognitive behavioral therapy (CBT) can help manage stress levels.

3. Dietary Considerations: Some patients benefit from dietary modifications, such as the ketogenic diet, which has been shown to reduce seizure frequency in some individuals. Consult with a dietitian familiar with epilepsy for personalized advice.

4. Avoiding Triggers: Keep a seizure diary to identify potential triggers, such as specific foods, activities, or environmental factors, and work to avoid them.

Advanced Treatment Options
If medication adjustments do not yield satisfactory results, there are advanced treatment options to consider:
1. Vagus Nerve Stimulation (VNS): This involves implanting a device that stimulates the vagus nerve and can help reduce seizure frequency.

2. Responsive Neurostimulation (RNS): This is a newer treatment where a device is implanted in the brain to detect abnormal electrical activity and deliver stimulation to prevent seizures.

3. Surgery: In select cases, surgical intervention may be considered if seizures are localized to a specific area of the brain and are not controlled by medication.

Conclusion
Managing epilepsy is a multifaceted process that requires a tailored approach based on individual needs and responses to treatment. It is vital to maintain open communication with your healthcare team, report any changes in your condition, and actively participate in your treatment plan. Regular follow-ups with your neurologist will help ensure that your epilepsy is managed effectively and that your quality of life is optimized. If you have any concerns about your current medications or treatment plan, do not hesitate to discuss them with your doctor.

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