What drugs can cause a seizure?
For epilepsy, the doctor may prescribe special drugs (anticonvulsants, anti-epileptic drugs). You lower the risk of epileptic seizures. Sometimes an operation (epilepsy surgery) helps
Whether treatment should be started for epilepsy, which therapy appears promising and how long it has to be continued, is ultimately always an individual decision. The doctor should, if possible, provide detailed information about the disease, suitable treatment methods and possible advantages and disadvantages.
Tips for everyday life
In general, it is advisable to avoid sleep deprivation. This reduces the risk of epileptic seizures. People with epilepsy should only drink small amounts of alcohol. If you realize that you have been drinking, that is already too much. However, there is usually nothing wrong with an occasional glass of wine or champagne.
Psychological counseling can make sense when it comes to coping with the illness in everyday life or at work. Young patients have to think carefully about their career choice. Because some workplaces may harbor particular risks if seizures occur - for example, working at great heights or driving a vehicle. Those affected should therefore inform themselves in advance from their neurologist (or pediatrician).
Driving a car with epilepsy?
The question of whether it is possible to drive a motor vehicle independently must also be clarified. Basically, a patient who suffers from epileptic seizures is only suitable if they remain seizure-free for a year. (Attention: There are also different regulations for different driving license classes and manifestations of the disease. Patients should definitely seek individual advice!). The medication against the disease (anticonvulsants) should not lead to an inability to drive if given good therapy. The treating neurologist will provide information here, and if necessary, an assessment of fitness to drive must be drawn up.
There are many different medicines on the market that are used for epilepsy. While they cannot cure the disease, they can reduce the likelihood of epileptic seizures. The drugs act as "seizure blockers" (anticonvulsants) - but only if they are taken regularly as prescribed. Frequently prescribed active ingredients are, for example: carbamazepine, oxcarbazepine, eslicarbazepine acetate, valproic acid (valproate), phenytoin, lamotrigine, levetiracetam, lacosamide, phenobarbital, pregabalin, ethosuximide, topiramate, more importantly, retigabine, zonisamide (to name just a selection) drugs (benzodiazepine, perampanel) .
When choosing the right medication, the doctor depends, among other things, on the type of epilepsy (see also the chapter on symptoms and causes). In addition, he must keep an eye on tolerability and possible drug side effects such as weight gain, liver strain, interaction with other drugs, and psychological reactions and adjust them to the patient.
Usually the doctor will start with a small dose of medication which is gradually increased to a range that is optimal for the patient. Medicines can also trigger severe side effects in individual patients, for example liver failure with valproic acid. Therefore, the doctor will advise the patient in detail and monitor the course.
In almost every second adult patient, even the first active ingredient can prevent future seizures. With a further 15 percent, this can at least be achieved in the second attempt: by switching to a different preparation. However, these figures are statistical values. If therapy with a single drug is unsuccessful, the doctor may prescribe a combination of drugs.
Caution, interaction: Some anticonvulsants can interact with other drugs, so that the effect is weakened or intensified. This must be taken into account, especially with so-called blood-thinning drugs such as coumarins, immunosuppressants or the "anti-baby pill".
Planning ahead for pregnancy: Women with epilepsy who wish to have children should think a little ahead if possible so that there is no risk to their unborn baby. The more carefully a pregnancy is planned in advance, the better. In particular, the therapy should be adjusted accordingly by the doctor beforehand. It is also important to have an adequate supply of folic acid.
Often important: supplement vitamins in a targeted manner
Patients who take certain epilepsy medications need to be extra careful with their vitamin supply. Often they even need vitamins in the form of preparations, as precisely tailored food supplements. Because the drugs influence the blood level of some vitamins. This applies in particular to so-called enzyme-inducing anticonvulsants such as carbamazepine, phenytoin, phenobarbital and primidone, but also to the enzyme inhibitor valproic acid. It has long been known that these drugs interfere with the vitamin D metabolism and can lead to osteoporosis. In addition, according to a study from 2011 in more than 3000 people, drugs such as carbamazepine, valproic acid (valproate) and phenytoin can lower the folic acid level, vitamin B9 / vitamin B11, in the blood. Active ingredients such as phenobarbital or topiramate may lead to lower vitamin B12 values. Both can have negative consequences, for example impaired blood formation and negative influences on cognition (the ability to think). It is best for patients to talk to their doctor about this.
Link to the summary of the study:
Antiepileptic drugs interact with folate and vitamin B12 serum levels *
* (www.apotheken-umschau.de is not responsible and assumes no liability for the content of external websites.)
Therapy for epileptic seizures
In an acute case, it is best for those affected to take an emergency card with a description of their illness and the precise treatment. He informs helpers quickly and reliably. To interrupt a (long) epileptic seizure, the doctor can, for example, administer benzodiazepines that can be pushed into the cheek pocket (lorazepam) or as a solution (midazolam) injected into the side of the mouth.
The best way to react when someone has an epileptic fit can be found in the First Aid chapter.
Stop taking medication again?
Under certain conditions, discontinuing drug therapy can be considered. Some childhood epilepsies "heal" over the years. Whether and when tablets can be dispensed with should always be discussed with the doctor in detail, as otherwise the seizures may occur again. About two thirds of all patients have to take medication for life.
Operations (epilepsy surgery)
In certain cases, surgical intervention is an option for treating epilepsy - for example, if medication alone does not bring the desired result. Whether such an epilepsy surgery appears promising is best clarified in a specialized center that has a lot of experience in this field.
If a very specific area of the brain - a "focus" - is the starting point of the epileptic seizure, this area can possibly be removed in an operation and the disease can be improved or ideally even cured. However, this intervention requires precise and sometimes complex planning. After all, no indispensable tissue must be removed from the brain during the operation. Modern diagnostic methods help to reduce this risk as far as possible in advance. As with any operation, complications such as bleeding or infection can occur.
Vagus Nerve Stimulation (VNS), which is used less frequently, is another way of reducing the frequency of epileptic seizures. A type of pacemaker is inserted into the patient's left chest below the collarbone in a small operation. A cable leads from there to the left vagus nerve on the neck. This cranial nerve also controls the function of internal organs. The "pacemaker" regularly stimulates the nerve with electrical signals. This affects brain activity so that fewer seizures occur. A VNS model has recently been on the market which, in addition to regular stimulation in patients, automatically stimulates the heartbeat (tachycardia) at the start of an attack. It can thus give off additional impulses to inhibit seizures.
Other stimulation methods, such as "deep brain stimulation", are currently very rarely used in epilepsy. Their real benefit has not yet been conclusively clarified. Such therapies should therefore take place within the framework of scientific studies at specialized institutions.
The so-called keto diet (a modified Atkins diet) is sometimes used with great success in childhood epilepsy that is difficult to treat. Diet measures should only be taken in consultation with a doctor.
Biofeedback therapy is also used in epilepsy, among other things. It has so far not been able to establish itself because of the unclear success situation.
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