What are the options if medications cannot control your epileptic seizures?

Question: I have tried several different medications for my epilepsy, but my seizures are not controlled. What other treatment options are there?

Answer: Unfortunately for some people with epilepsy, currently available medications are unable to completely control seizures. In fact, for about 1 in 3 with epilepsy, seizures remain uncontrolled. This is called "medication resistant" or "refractory" epilepsy.

Once an individual does not respond to trials of three different seizure medications, the chance for complete seizure control is less than 10 percent. Fortunately, there are other options available that may offer good chances for seizure control.

Categories of Epilepsy

The first step in determining treatments for medication resistant epilepsy is to determine the epilepsy syndrome. There are two major categories of epilepsies: partial in onset and generalized in onset.

In partial epilepsy, seizures begin in a specific or focal area of the brain. In the generalized epilepsies, seizures do not arise in a focal region of the brain, but involve the entire brain at seizure onset.

The distinction between partial and generalized epilepsies is made by taking a complete history of the epilepsy (age on onset, types of seizures) and by using the electroencephalogram (EEG).
The type of epilepsy affects the choice of medication because some seizure medications are not effective for generalized epilepsies. Thus, one of the potential reasons that an individual may continue to have seizures is the incorrect medication is chosen for the epilepsy type.

Another Option

If a patient has partial epilepsy, then surgery may be an excellent treatment option and may offer up to a 60 to 90 percent chance of seizure freedom depending on the results of a comprehensive pre-surgical evaluation.

The evaluation for surgery is performed at specialized epilepsy centers and basically involves pinpointing the location in the brain of seizure onset. There are multiple tests that are performed including video/EEG monitoring, several different brain imaging tests and testing of language and memory function.

Unfortunately, many patients who are good candidates for epilepsy surgery are never referred for evaluation and these individuals continue to have unnecessary seizures despite being excellent candidates for surgery.

This week's NetWellness column is authored by Dr. David M Ficker, associate director, Cincinnati Epilepsy Center, Department of Neurology, College of Medicine, University of Cincinnati.
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You can visit the National Association of Epilepsy Centers web site to locate the closest epilepsy center.