Acute epileptic seizures, new medications and advancements in surgical treatment options

Main Category: Public Health
Article Date: 06 Aug 2004 - 11:00 PDT

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New medications and advancements in surgical treatment options are providing relief of seizures for the millions of people living with epilepsy.

Epilepsy is one of the most common disorders of the nervous system and more than 2.5 million Americans of all ages are living with the condition, according to the Epilepsy Foundation. Each year, an estimated 181,000 Americans will have seizures from epilepsy for the first time. The condition can develop at any point in life, especially in early childhood and old age.

"Demographic data has shown that about one out of every 200 people has epilepsy," says Gregory L. Barkley, MD. "However, as many of 5% of the population will have a seizure at some point in their life. Genetic factors and complications during pregnancy can play a role in the development of epilepsy in children. In the elderly population, the genetic epilepsy can run its course during the first few decades of life, but tends to diminish as the brain matures. However, the elderly population can develop epilepsy later in life if an event occurs in the brain, such as head trauma, stroke, or a brain tumor."

A study published in March-April 1989 issue of Epilepsia estimates that about 1% of patients who come to the emergency department (ED) do so because of seizures. Dr. Barkley says many patients with epilepsy commonly present to emergency rooms after a seizure has occurred. Treatments and evaluations for this patient population can change according to the situation.

"When an epilepsy case presents in the emergency department, physicians will assess the patient and often administer a loading dose of medicine to treat the seizures," explains Dr. Barkley.

"One of the most commonly used drugs for epilepsy in the ED setting is phenytoin, but the drug may not act immediately. If a patient is having an active seizure in the ED, they will usually need benzodiazepines to reduce the seizure faster." Benzodiazepines enter the blood stream and migrate into the brain to stop the seizure.

Dr. Barkley says timing is critical when treating epileptic seizures in the ED. "Some medications will only control an acute seizure for 15 to 20 minutes, and that may not be enough time.

Other medications have lower lipid solubility and provide physicians with a longer duration of effective treatment.

The choice of drug depends largely on the patient in need. If the patient seems likely to have another seizure while in the care of their emergency physician, then controlling the seizure longer may be more important." CONTINUES....Physician's Weekly

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