Treatment of epilepsy: conservative and surgical methods
- 15 Jun 16:15
- Indications for conservative treatment of epilepsy
- principles of pharmacotherapy of epilepsy
- main antiepileptic drugs
- stages antiepileptic treatment
- Surgical treatment of epilepsy
treatment of epilepsy - a serious and difficult task, principleswhich remain the same for many years: early start, individual approach,continuity and duration of therapy. The purpose of treatment for epilepsy is not the attack, and not even a disease, but an improvement in the quality of human life. In no case can you seek to eliminate the attacks "at all costs," as the side effects of antiepileptic drugs( AEPs) may exceed the benefits of their appointment.
The main method of treating epilepsy, both in adults and children, is conservative therapy through the regular admission of special anticonvulsant drugs. Today, one dozen such medicines are known and used in practice. They all belong to highly effective medicines and are released strictly on prescription. Each of them has its own contraindications and side effects, which must be taken into account when compiling the therapeutic program.
Video transmission about epilepsy :
Live healthy! : Epilepsy 09.12.2013
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Often, to control the disease, you have to appoint more than one AEP, which requires careful dose selection, as well as caution in the patient's behavior., because antiepileptic drugs have high ability for various medical interactions and spontaneous overdose. Therefore, all patients with this disease need regular medical monitoring of the amount of active substance in the blood, as well as other research methods for the early detection of side effects.
In the case of conservative treatment contraindicated or unproductive, surgical procedures for the treatment of epilepsy may be used.
Indications for conservative treatment of epilepsy
Consider the basic principles by which doctors prescribe permanent antiepileptic therapy, as well as cases where anticonvulsants are not prescribed.
Therefore, it is not necessary to prescribe specific pharmacotherapy after the first epileptic seizure in the case of:
- if a child of childhood and he lacks the risk factors for the further development and progression of epilepsy;
- if the assault occurred in a pregnant woman, while the pregnancy is not complicated and there are no risk factors for recurrence of the attack;
- if the onset is symptomatic in the face of some other acute illness;
- if the occurrence has developed due to the long absence of sleep.
Situation when the appointment of specific antiepileptic therapy after the first attack is mandatory:
- debut disease with epileptic status;
- if the physician is convinced that the patient has started an idiopathic, not symptomatic, generalized form of epilepsy;
- if a person has a neurological disorder that causes seizures;
- if, according to the results of the EEG, epileptic activity of the brain is recorded;
- in the history of the present is a birth trauma or other organic pathology of the brain;
- if there are cases of epilepsy in the family;
- if there are specific epileptic changes in the psyche.
Principles of pharmacotherapy for epilepsy
The choice of medication, its dose, and the mode of administration depend on the following factors:
- type of epileptic seizures;
- age and gender of the patient;
- presence of concomitant diseases;
- social and economic conditions of human life and opportunities;
- patient specific features;
- presence of contraindications to one or another medication.
Treatment of epileptic seizures always starts with monotherapy( using 1 drug), while using drugs from the selection group depending on the type of seizures. The effectiveness of such treatment is evaluated after 3 months of regular intake. Only after this time can we draw a conclusion on the effectiveness of the chosen drug, as well as to make correction of therapy. If you do this before, you can cause the development of pharmacokresistance.
If, after 3 months of regular use, the effectiveness of the medication is small, then prescribe other medications from the selection group as well as monotherapy.
If, after 3 months of taking another antiepileptic drug, seizures remain, then prescribe combination therapy 2 antiepileptic drugs. Ineffectiveness of such a combination continues to search for medicines to eliminate seizures. This includes an alternative group of drugs. If all the options are tested, then assign 3 AEP at the same time. The use of more than 3 drugs is not used, as it is considered inappropriate and dangerous to the patient.
If to refer to the statistics, then 20-30% of patients with epilepsy, despite the adequate selection of drug treatment, remain sensitive to conservative treatment, which requires the use of more radical methods, such as surgical treatment.
Treatment of epilepsy should be long, consistent and continuous in order to succeed. Patients should adhere to the dosage of doses and the frequency of their administration. In no case can you miss the drug, even if the attacks have not been long ago. Any violation in the mode of taking dasgs can lead to a secondary insensitivity of the patient to pharmacological treatment and progression of the disease.
Drug Treatment Targets :
The main antiepileptic drugs
Consider first-line antiepileptic drugs.
This drug is a choice in case of partial attacks in any form of epilepsy. You can not use it with absences and myoclonic convulsions. In addition to anticonvulsive abilities, it has a psychotropic effect. The dose in adults is 500-1600 mg per day in 2-3 times the admission.
Common side effects of carbamazepine :
- Drowsiness, disturbances, dizziness, duplication in the eyes, headache;
- skin rash;
- decrease in the number of formed blood elements;
- disturbs the concentration of sex and thyroid hormones.
Carbamazepine treatment requires regular monitoring of drug concentrations in the blood.
For the treatment of epilepsy, sodium is used( Depakin, Convulex, Apilepsin) and potassium salt( Convulsophen) valproic acid. Medications from this group - the choice of idiopathic form of the disease in the case of absences and myoclonic trial, but they are also used in partial attacks.
Monitor the concentration of valproate in the blood is not necessary, as the side effects are dose-dependent. The daily dose for adults is 20-40 mg per kilogram, in children - 60 mg per kilogram. Medications from this group contribute to increasing the concentration of blood in other AEP, which must be taken into account in combination therapy.
Common side effects :
- toxic effects on the liver;
- reduces blood coagulation, which increases the risk of bleeding;
- at high doses may result in drowsiness, trembling of the limbs, dizziness, headache, nausea, hair loss, disturbances;
- increase body weight;
- dyspeptic phenomena.
Selection tool for tonic-clonic convulsions, tonic and partial episodes. Contraindicated with absans. Treatment with phenytoin requires continuous medical monitoring, since overdose easily occurs, and they do not depend on the dose.
Dose for children 5-12 μg per kilogram per day. The drug significantly reduces the concentration of carbamazepine in the blood, because their combination is irrational.
Common side effects :
- rhythmic blinking of eyeballs;
- drowsiness, headache, vertigo;
- causes prolonged toxic damage to the cerebellum;
- high hair growth;
- coarse facial rice;
- hyperplastic gum phenomena.
The drug is used in all types of both partial and generalized attacks. The drug is prescribed in the minimal doses at night. For children 5-12.5, for adults - 25 mg. The dose is increased every 2 weeks, gradually leading to a therapeutic. Treatment does not require medical monitoring, since all effects are dose-dependent.
Among the possible side effects, one should note most often - a rash that can progress and complicate the Stevens-Johnson syndrome( a life-threatening condition).
Among the drugs of the alternative group, it can be noted:
In any case, the choice of the drug, its dose, the mode of reception, the need for a combination makes a specialist. From the patient it is necessary not to violate any mode of therapy in any way.
Stages of Antiepileptic Treatment for
There are 3 stages of treatment for epilepsy in adults and children.
Selection of the dosing regimen and
It is necessary to choose the appropriate drug or drugs for the treatment of various types of attacks, taking into account the individual characteristics of the patient as well as the age. Dosage should be taken into account for children, adults and the elderly. Unfortunately, in 20-30% of patients it is not possible to choose the therapy that would control the course of the disease. In this case, they talk about the primary resistance to epilepsy. If the effectiveness of medicines has decreased after their initial good effect due to non-compliance of the patient with the dosing regimen, then this is secondary resistance.
This is a very important step in the treatment of epilepsy, which is often difficult to follow. The absence of attacks for 2-3 years introduces the patient, his family, and sometimes the doctor to mislead. Doses of drugs are reduced or they are abolished altogether. But this does not mean that the disease has retreated, and in case of disrupting the dosage of drugs, the attacks develop again.
Gradual abolition of AEP
As a rule, the beginning of the discontinuation of treatment for epilepsy begins after 3 years of persistent remission. In children who are in puberty, discontinuation of drug therapy should not be required even after remission for 3 years, as this period itself is characterized by increased epileptic readiness. Drug doses are discontinued gradually. If a patient has taken several dasgs, they will be quashed one by one. The risk of recurrence occurs in 15-25% of cases after cancellation for 5 years.
Surgical treatment of epilepsy
Surgical treatment resorts in the following cases:
- resistance to pharmacotherapy of epilepsy, when numerous attacks significantly impair the quality of human life;
- when medication is effective, but the patient can not tolerate side effects of therapy;
- when, according to a supplementary study, it has been shown that attacks occur in small and clearly limited areas of the brain that can be removed.
Surgical treatment in the case of primary generalized episodes with loss of consciousness is not used.
Video transmission about surgical treatment of epilepsy:
Surgical treatment of epilepsy
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To eliminate attacks, a neurosurgical removal of the pathological focus in the brain is used. This is especially effective when symptoms are caused by cysts or brain tumors. Various variants of resection are also used - lobectomy, hippocampectomy, calcezotomy, hemiferotomy. These are very severe and invalidating interventions that are used only in extreme cases, for example, in this form of epilepsy, such as Rasmussen's encephalitis.