WITH the medical and technological advances currently available, epilepsy and the seizures that characterise it need not be a hindrance to a full and active life.

Treatment for epilepsy is aimed at not only abolishing all seizures, but also managing the patient as a whole.

As such, effective treatment of epilepsy begins with an accurate diagnosis of the type of seizure a patient suffers, as various seizure types respond better to specific treatments.

The first thing a doctor will do is to take the patient's medical history. This may include questions on the patient's family history of seizures and a detailed description of the seizures.

A family member or someone who witnessed the seizure must be present to provide additional information, especially if the patient had been unconscious.

This will usually be followed by physical and neurological examinations to identify associated physical signs that may point to a particular epilepsy syndrome.

The doctor may suggest further tests to better understand the cause of the seizures and detect possible abnormalities in the brain.

These tests may include electroencephalogram (EEG), which measures electrical impulses in the brain, computerised tomography (CT) and magnetic resonance imaging (MRI), which, very simply, provide images of the brain.

Drug options

Once a proper diagnosis is reached, the doctor will suggest a number of treatment options. Epilepsy is almost always treated using antiepileptic drugs (also known as anticonvulsants or anti-seizure drugs). The standard modern treatment for most types of epileptic seizures is regular use of one or more antiseizure drugs.

There are more drugs available today to control seizures than ever before. In fact, there are more than 20 different medications now on the market, with about 10 being commonly used in Malaysia.

Each drug is slightly different, works better on certain kinds of epilepsy, and like all medication, has some side effects.

People react differently to anti-seizure medication just as they do to foods or any substance that enters the body.

As such, the doctor will try to determine the right anti-seizure medication for a particular patient and will prescribe a suitable programme that achieves the greatest degree of seizure control with the fewest side effects.

Some factors the doctor will consider when prescribing antiseizure medication will include the type(s) of seizure, the patient's age, gender, IQ level and health issues, and other medications the patient may be taking.

To achieve the best seizure control possible, patients should take medications exactly as prescribed, and always check with the doctor before taking other prescription medications, over-the-counter drugs or herbal remedies. Certain substances can interfere with epilepsy medication and reduce its effectiveness.

For the best outcome, people with epilepsy should first consult a trained, licensed healthcare practitioner instead of opting for "alternative" treatments.

Free of seizures

Most people with epilepsy can be seizure-free for long periods of time with the right treatment.

It has been shown that about 80% of people with epilepsy treated with seizure medicines remain free of seizures for at least two years.

In adults, 50% to 60% will be seizure-free after using their first seizure medicine.

Among those who are young when their epilepsy is diagnosed, 20% start on medication and never have another seizure after medication is stopped, even when they reach adulthood.

The more time that passes without seizures, the greater the chance of staying seizure-free and over 50% of children outgrow their epilepsy.

Most people with epilepsy can control their seizures with medication. But drugs alone may not be effective for a minority of patients. In some cases, surgery may be an option.

Surgical intervention

Surgery can help in treating an underlying condition, such as when the patients' seizures are caused by a growth, tumour or other conditions.

If the underlying condition is successfully treated or removed, the patient's seizures usually stop as well. As such, about 5% of epilepsy patients can be "cured" through surgery.

Surgery can also be prescribed to remove the seizure focus (the area of the brain where the seizure originates), but is only suitable for partial seizures that originate in a single, well defined area of the brain.

People who are potential candidates for surgery need to undergo a rigorous pre-surgical evaluation by a neurologist. This may take up to six months to complete.

If the neurologist is of the opinion after the evaluation that the patient is not a suitable candidate, the patient will be strongly discouraged to undergo surgery and prescribed other treatment options.

The pre-surgical evaluation is crucial because there are an astonishing 25% of people with chronic epilepsy who, sometimes unbeknownst even to themselves, do not actually wish to be cured.

Such patients become depressed and anxious after successful surgery because they are faced with the prospect of independence which they are not prepared for after years of relying on caregivers for their many needs.

When assessing a patient's potential for surgery, a doctor will take a holistic approach and discuss not just a patient's seizures and medical details, but a whole range of "life issues" such as education, sports activities, social life, employment and even driving. Marriage and pregnancy are of particular importance when evaluating female patients.

Most patients show satisfactory improvement with surgery. Its effectiveness can vary: some people are completely free of seizures after surgery, while for others, the frequency of seizures is significantly reduced.

Most patients can reduce or even stop taking anti-seizure medication after a period of time post surgery.

However, as with any surgery, there are risks.

VNS device

Vagus nerve stimulation (VNS) is yet another treatment option for epilepsy.

A device called a vagus nerve stimulator is implanted beneath the skin on the patient's chest. Wires from the stimulator are wrapped around the vagus nerve.

The vagus nerve connects the brain to the heart, lungs and gastrointestinal tract. The device generates pulses of electricity at regular intervals, stimulating the vagus nerve. This brain stimulation via the vagus nerve reduces the number of seizures.

Patients who undergo VNS may find it possible to reduce the dosage of medication.

VNS may be a treatment option for people for whom anti-seizure drugs are not effective and who, for any number of reasons, are not considered good candidates for surgery.

However, this mode of treatment can be costly; moreover, the battery that powers the device lasts only about five years.

Diet can help

Another treatment for epilepsy in children is the ketogenic diet, which is essentially a diet that is high in fat and low in carbohydrates.

It is intended to maintain a "starvation mode" in the body over a long period of time. When the body is in a fasting state, it creates ketones, indicating that the body is burning fat instead of glucose for energy.

The exact way in which the ketogenic diet works is unclear. However, studies of children on the ketogenic diet have shown that their seizures lessen or disappear.

It should be made clear that the ketogenic diet is not an easy diet to maintain, and it can produce effects such as high levels of uric acid and kidney stones. Children on the diet often will not gain weight and may even experience slower growth during the time the diet is in use.

This diet should be undertaken only under strict monitoring and guidance from a neurologist familiar with its use, a dietitian, and a paediatrician.

There are a number of ways that a person with epilepsy can manage his or her condition, and knowledge is the key. Armed with the options outlined above, a person with epilepsy should discuss his or her condition with a neurologist and take the first steps to achieving better health and quality of life.

Prof Dr Raymond Azman Ali is a senior consultant neurologist at a hospital in Kuala Lumpur and also the Chairman of the Epilepsy Council, a subspecialty council under the Malaysian Society of Neurosciences. He will be speaking at a public forum in Malacca organised by Persatuan Epilepsi Malaysia on June 28, International Epilepsy Day. The forum is made possible through an educational grant by UCB Pharma Asia Pacific Sdn Bhd. Members of the public are welcome. For more information on epilepsy, please go to www.epilepsy.org.my or www.livebeyondepilepsy.com

This article was first published in The Star on June 22, 2008.