Impact of therapy on intellect and prevention
Antiepileptic drugs affect the patient's higher nervous activity in different ways. This factor must be taken into account when choosing therapy:
- Impair cognitive processes and reduce information assimilation: benzodiazepines, carbamazepine, and barbiturates.
- Improve cognitive functions: levetiracetam, lamotrigine.
Medication support is actively used for the nonspecific prevention of seizures. Nootropic drugs such as pyritinol or nicotinoyl GABA are prescribed (glutamic acid is indicated for children). Vitamin therapy (pyridoxine) and course administration of magnesium sulfate have a positive effect.
Diet therapy may be used additionally. Patients are advised to limit fluid and table salt intake. In some cases, a ketogenic (high-fat) diet is prescribed. It artificially induces metabolic acidosis, which helps reduce seizure frequency. However, such a diet is far from the physiological norm and is not suitable for all patients.
Correction of concomitant mental disorders
The long-term course of epilepsy is often accompanied by personality changes and psychotic episodes. Carbamazepine, as well as mild antipsychotics used as behavioral correctors (risperidone, thioridazine, quetiapine, periciazine), are used to mitigate personality degradation, dysphoria, and depressive manifestations.
Danger of tranquilizers: episodic use of benzodiazepines and barbiturates (including popular drops like Valocordin) is extremely undesirable. Sharp fluctuations in the concentration of these substances in the blood provoke new seizures.
The treatment of psychoses in epilepsy depends on their nature:
- Acute psychoses are managed with potent sedative antipsychotics (haloperidol, chlorpromazine, olanzapine, levomepromazine).
- Chronic psychoses require the administration of drugs that suppress productive symptoms (trifluoperazine, haloperidol, risperidone).
Important to remember: prolonged intake of certain psychotropic drugs can independently provoke seizures. These include antidepressants (mirtazapine, mianserin, tricyclic antidepressants) and a number of antipsychotics (clozapine, phenothiazines).
Daily routine and social adaptation
With adequate and effective treatment, patients are able to lead a full life, although a number of restrictions must be observed.
Trigger factors to avoid:
- Night shift work (sleep deprivation sharply increases seizure susceptibility).
- Heavy physical exertion (risk of hyperventilation).
- Excessive sun exposure (solar radiation).
Strictly prohibited:
- Consumption of any alcoholic beverages.
- Driving motor vehicles.
- Working at heights, near bodies of water, or with moving machinery.
Disability status is far from always granted. Disability is indicated only in severe cases: with frequent seizures that do not respond to drug control, as well as with pronounced negative symptoms (profound personality changes, development of epileptic dementia).
Tactics during an epileptic seizure
Providing assistance at the time of a seizure requires coolness and adherence to clear rules.
The main objective is to prevent patient trauma during a fall and during the clonic phase of seizures. It is strictly forbidden to try to administer any anticonvulsants directly during a seizure. The paroxysm usually ends on its own, and consciousness fully returns within 1–2 minutes.
If a seizure occurs in a person for the first time in their life, urgent hospitalization and a thorough examination to identify the causes are necessary. The mandatory diagnostic minimum includes:
- Taking a detailed medical history.
- Examination by a neurologist and ophthalmologist.
- Performing an EEG (electroencephalography).
- Neuroimaging (CT, MRI) and skull radiography.
Briefly: answers to topical questions
What non-pharmacological methods of treating epilepsy exist?
Non-pharmacological methods of treating epilepsy include diet therapy and surgery.
- Diet therapy includes restricting salt and fluid intake, as well as using a ketogenic (high-fat) diet. The ketogenic diet leads to the development of acidosis, which helps reduce seizure frequency.
- Surgical treatment is considered in pharmacoresistant cases of the disease (for example, in post-stroke epilepsy or focal cortical dysplasia).
Which first-line drugs are used to abort status epilepticus?
Benzodiazepine tranquilizers are used as first-line drugs to abort status epilepticus. The following medications are used in emergency therapy:
- Diazepam is a first-line drug for status epilepticus.
- Lorazepam is a first-line drug for status epilepticus.
- Clonazepam is a first-line drug for status epilepticus.
What EEG changes are characteristic of typical absence seizures?
Typical absence seizures (petit mal) are characterized by EEG changes typical of generalized (idiopathic) seizures. The dynamics of electroencephalogram changes include:
- Seizure onset — bilateral synchronous epileptiform activity is recorded, indicating the involvement of neuronal networks on both sides of the brain.
- Interictal period — there is a complete absence of pathology on the EEG.
What are the indications for surgical treatment of epilepsy?
The main indication for surgical treatment of epilepsy is a pharmacoresistant course of the disease. Surgical intervention should be considered in the following clinical situations:
- Post-stroke epilepsy — in case of a pharmacoresistant course.
- Focal cortical dysplasia — in pharmacoresistant seizures; patients are considered candidates for surgical treatment if resectable foci are identified.
- Brain tumors — surgical intervention is the main and only radical method of treating the tumor.
The 'SAN' seizure trigger rule: Sleep (deprivation/night shifts), Alcohol (strictly prohibited), Exertion (heavy physical labor and hyperventilation).
Class and exam questions
Should anticonvulsant medications be administered by injection during a seizure?
No, this is strictly prohibited. Seizures stop on their own within a couple of minutes; the main task is to protect the person from injuries.
Can a patient with epilepsy drive a car if seizures are infrequent?
No, driving vehicles, as well as working at heights, around water, and with moving machinery, are strictly prohibited in epilepsy.
Is disability status granted for a diagnosis of epilepsy?
Disability is granted only in cases of frequent seizures that are not controlled by treatment, as well as in cases of severe dementia or personality changes.
Is it safe to take Valocordin or Corvalol for stress?
These drugs are contraindicated in patients with epilepsy. They contain barbiturates, the episodic use of which causes sharp fluctuations in blood levels and triggers seizures.
What else to study on this topic
- Ketogenic Diet: Pathophysiology of Metabolic Acidosis
- Specific Personality Changes in Epilepsy
- Differential Diagnosis of a First-Time Seizure
- Mechanism of Action and Side Effects of Carbamazepine
- Procedure and Interpretation of EEG
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Other topics in "Chapter 20. Epilepsy"
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