Epilepsy Treatment: Insights and Future Options

Epilepsy treatment

My description may be somewhat complex, but I sincerely ask all physicians to provide me with detailed answers and suggestions.
My birthday is October 11, 1970.
During the summer vacation of my second grade in elementary school (around 1978), I experienced a fall from a slope approximately 2 to 3 meters high, resulting in a dislocated right arm.
A month later, my dislocated arm healed, but my family noticed that I had intermittent episodes of loss of consciousness.
Initially, these episodes lasted only a few seconds and sometimes included urinary incontinence, which later ceased as I grew older.
My family took me to a neurology hospital for treatment and medication, but there was no significant improvement.
Later, in the third grade, my family took me to Taipei Veterans General Hospital for treatment (I believe I was prescribed medications like Epilim).
After several years without improvement, the duration of my episodes increased, and I began to experience seizures.
Subsequently, a physician in Taipei recommended that I consult Dr.
Chiang Chi-Hsun in Kaohsiung (since I live in Kaohsiung).
I have been receiving treatment at Kaohsiung Medical University Hospital, where Dr.
Chiang prescribed me medications such as Depakine and Epilim, which I have been taking continuously.

During my middle school years, my family and doctors decided to refer me to the neurology department, and I have been under the care of various physicians at Kaohsiung Medical University Hospital, including Dr.
Liu Ching-Kuan, Dr.
Wei Jung-Chou, Dr.
Lai Chiu-Lien, Dr.
Dai Chih-Ta, and Dr.
Lai Hsiang-Jung, among others.
Currently, my attending physician is Dr.
Lai Hsiang-Jung, and I have been under his care for approximately 10 to 20 years.
Since my referral to the neurology department, I have been taking DEPAKINE CHRONO 500mg from Sanofi and Lamictal 50mg from GlaxoSmithKline Taiwan.
My current dosage is DEPAKINE 1 in the morning and 1 at night, and Lamictal 1 in the morning and 2 at night.
A few years ago, I visited Taipei Veterans General Hospital again (because I heard that surgery could remove the area causing the seizures and potentially cure me), but the physicians (Dr.
Yen Te-Chen and Dr.
Kuan Shang-Yung) concluded that I was not a candidate for surgery, stating that it could leave me in a vegetative state.

Having been on medication for so long without any change, I have also noticed a decline in my memory (which the doctors attributed to medication side effects).
I am concerned that if I continue this way, I may develop dementia.
I would like to ask the physicians: must I continue taking medication for the rest of my life? I have heard about gene therapy and embryonic stem cell treatments; could these be used to cure my condition? If so, how should I seek treatment? I hope the esteemed physicians can provide groundbreaking advice or guidance.
I would be eternally grateful.

g, 30~39 year old female. Ask Date: 2009/01/01

Dr. Lin Zijing reply Neurology

Currently, there is no particularly effective method for treating epilepsy; the goal is to control seizures and minimize their occurrence.
Good seizure control requires the following conditions: 1.
Regular outpatient visits and adherence to the physician's instructions regarding the prescribed medication dosage (treatment may vary for each individual).
2.
A balanced diet and adequate sleep.
3.
Avoiding excessive fatigue and not staying up late.
4.
Abstaining from alcohol; if there is a history of alcohol consumption, it should not be abruptly discontinued but rather gradually reduced before cessation.
5.
Engaging in appropriate exercise and legitimate social activities.
6.
Maintaining a relaxed and positive mental state.
Poor seizure control can lead to a decline in brain function, such as slowed reactions and impaired memory.
If your current medication effectively controls seizures with minimal occurrences, you should continue taking it to prevent potential complications from any future seizures.

Reply Date: 2009/01/01

More Info

Understanding epilepsy treatment is a multifaceted issue that involves various approaches, including medication, lifestyle changes, and emerging therapies like gene therapy and stem cell treatment. Your journey with epilepsy, which began after a fall during childhood, highlights the challenges many face in managing this condition.
Epilepsy is a neurological disorder characterized by recurrent seizures, which can vary in type and severity. The treatment typically begins with antiepileptic drugs (AEDs). In your case, you have been prescribed Depakine (valproate) and Lamictal (lamotrigine), both of which are commonly used to control seizures. However, it appears that despite long-term medication, you have not experienced significant improvement, and you are concerned about the potential cognitive side effects of these drugs, including memory issues.

It is important to understand that while AEDs can be effective in controlling seizures, they can also have side effects, including cognitive impairment. This is particularly concerning for individuals who have been on these medications for an extended period. If you are experiencing worsening memory or cognitive function, it is crucial to discuss this with your neurologist. They may consider adjusting your medication regimen or exploring alternative treatments.
Surgical options for epilepsy, such as resective surgery, are typically considered when seizures are not well-controlled with medication and when there is a clear focus of seizure activity in the brain. However, as you mentioned, your doctors advised against surgery due to the risks involved, which is a common concern in cases where the potential for significant neurological impairment exists.

Emerging treatments, including gene therapy and stem cell therapy, are areas of active research in epilepsy management. Gene therapy aims to correct or modify the underlying genetic causes of epilepsy, while stem cell therapy seeks to repair or regenerate damaged brain tissue. While these approaches hold promise, they are still largely experimental and not widely available as standard treatments. If you are interested in exploring these options, it would be advisable to consult with a specialized epilepsy center or a neurologist involved in research on these therapies. They can provide you with the most current information and help determine if you are a candidate for any clinical trials.

In terms of your concerns about being on medication for life, it is essential to have an open dialogue with your healthcare provider. They can help you weigh the benefits and risks of continuing your current treatment versus exploring new options. Additionally, lifestyle modifications, such as stress management, regular sleep patterns, and avoiding seizure triggers, can also play a significant role in managing epilepsy.

Finally, it is crucial to address your emotional well-being. Living with a chronic condition like epilepsy can lead to feelings of frustration, anxiety, and depression. Seeking support from mental health professionals, support groups, or counseling can be beneficial in coping with these feelings.

In summary, while your current treatment regimen may not be yielding the desired results, there are options available for further evaluation and potential adjustment. Engaging with your healthcare team about your concerns, exploring new treatment avenues, and focusing on your overall well-being can help you navigate this challenging journey.

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