Cesar Santos: Hi! my name is Dr. Cesar C Santos, Professor and Chief of Pediatric Neurology. I am one of the Clinical Epileptologist here at Georgetown University Hospital.
Today I am going to talk about medical treatments of Epilepsy. When we see patients in the clinic for consultation, the first thing we do is to determine whether they have epilepsy. When that decision is made, the next thing that we do is to try to determine what kind of seizures or epilepsy or epilepsy syndrome they are having because that's going to dictate and tell us what would be the most appropriate antiepileptic drug to use.
We generally divide antiepileptic medications into two, one is what we call the narrow-spectrum antiepileptic drug which works specifically for just the certain type of seizures and then there are the broad-spectrum antiepileptic drugs which works against different types of seizures.
The next question that we ask ourselves is which one would be least likely to produce side effects and still give us good likelihood of making them seizure-free. And if you use the right medication, you are going to make that patient seizure-free 47% of the time without first drug. Should that first medication fail, you could use one or two more, a single drug and still be able to control a little over 60% of patients.
Now what's commonly done is if you have been seizure-free for two years, we talk about possibly winding you off of medication. Treatments in children and adults, if you look at the different medications, they are basically the same thing. The medications that we use originally are marketed however, after studies have been done in adults. And then after they have been in the market for quite sometime, this is when we do, start this, that primarily deal with children, between children and adults we calculate the dosing in children based on their bodyweight. When two or more anti-epilepsy medication fail, we couldn't see that patient as a treatment to failure and we refer that patient for non-medical treatment. Non-medical treatment would mean surgical option or there are also non-surgical options which include ketogenic diet. Ketogenic diet is a special diet that needs to be instituted on in patient where we have to change the diet completely so much so that three to four parts of their whole caloric intake is derived from fat. We don't really know how the ketogenic diet works. But if you follow the diet strictly and maintain a certain degree of ketosis, these patients usually may end up having much less number of seizures per day.
Although, no single cure for epilepsy exists, many patients respond well to medications and surgical options and are able to lead normal lives.