The Epilepsy is a chronic and recurrent seizure disorder of the cerebral cortex, which affects all age groups, especially children and people over 70 years. According to the International League Against Epilepsy, attached to the World Health Organization, it is estimated that around 30% of the population does not receive adequate treatment to control this disease, and this situation occurs, above all, in populations with low economic resources.
The Epilepsy has no cure, but if controlled by taking medicines called anticonvulsants, antiepileptics or anticonvulsants. These anticonvulsants should be indicated by the internist or neurologist, after the diagnosis of epilepsy and according to the physical, psychological and social context of the patient.
Goals of epilepsy treatment
The fundamental objective for the treatment of epilepsy is to eliminate or control seizures, avoiding adverse effects produced by the use of anticonvulsants.
Currently there are several types of anticonvulsants, however, the treatment of choice will be indicated according to the health status of the patient, their possible adherence to treatment and their economic capacity to acquire it.
The choice of medicine must be made by the doctor, considering that he must avoid side effects and interaction with other medicines, so it is preferred that treatment be with a single medicine (monotherapy).
Another important aspect to take into consideration is to choose the drug that, due to its mechanism of action, is the ideal one to treat the type of seizure that the patient presents according to their medical history, that is, some anticonvulsants are effective to treat generalized seizures (secondary to abnormal activity of the whole brain) and others, are ideal for treating partial seizures (generated in only one brain region).
Medical treatment of epilepsy
It is estimated that about 70% of patients achieve seizure control with the use of antiepileptic drugs. The medical treatment will then depend on the type of crisis and that this type of epileptic syndrome patient:
· In absence seizures: treatment may be based on ethosuximide, but if absence seizures are accompanied by another type of seizure, valproic acid, lamotrigine or topiramate may be indicated. Other anticonvulsants due to their mechanism of action could rather exacerbate absence seizures.
· In tonic, myoclonic or tonic-clonic seizures, drugs such as topiramate, lamotrigine and valproic acid are used, varying according to the type of specific syndrome that the patient presents (for example, in some syndromes, such as Juvenile Myoclonic Syndrome, acid may be used valproic in conjunction with levetiracetam).
· Generalized seizures and seizures without a specific type: the treatment of choice is valproic acid. However, other antiepileptic drugs such as carbamazzein, phenobarbital lamotrigine and topiramate can also be used.
· Focal seizures: There are several types of options such as carbamazepine, lamotrigine, oxcarbazepine, phenytoin, and topiramate.
· First seizures: during the first seizure and even seizure status, benzodiazepines (such as diazepam and lorazepan) are used because they are short and fast acting.
It is important that the choice of anticonvulsant is made by the internist or neurologist, since all these drugs have important side effects that must be avoided and monitored.
Other treatments for epilepsy
· Electrical stimulation for refractory epilepsy: which is done through stimulation of the vagus nerve or by magnetic stimulation of the cerebral cortex. In the case of vagal stimulation, a device located in the neck produces signals through electrical generators (the size of a pacemaker for the heart), it causes the vagus nerve to send signals to the brain causing the modification of the thresholds of the seizures In the case of direct stimulation of the cerebral cortex, it is also performed by a device that sends signals to the brain and is also capable of controlling epileptic episodes.
· Surgery for epilepsy: it is estimated that 20% of epilepsy cases may be refractory to medical treatment. However, not all people are candidates for surgery. To propose a surgery (which consists of resecting the segment of the cerebral cortex that emits epileptogenic discharges) the patient must meet a series of requirements such as, for example, that when removing the area that is generating the epilepsy, damage or sequelae do not occur important for the life of the patient and that the epileptogenic zone is located in a certain area.
Epilepsy and diet
Some studies recommend the ketogenic diet (including the Atkins diet) in patients with epilepsy, which consists of a diet rich in saturated fats of vegetable origin (avocado, nuts, among others) and eliminating carbohydrates and sugars, in order to that the body uses fat as its main source of energy.
It is not well described why this type of diet works, but the production of ketone bodies is believed to decrease the frequency of seizures. According to some studies, it has been used in children refractory to conventional treatment.
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