Epilepsy and epileptic syndrome

Questions that arise during the treatment of the patient and their answers.

Question. Why is monotherapy chosen to treat epileptic attacks?

Answer. In most cases, 2 anticonvulsants give the same result as 1 anticonvulsant. The monotherapy method reduces the harmful effects of anticonvulsants on the body, as 2 anticonvulsants can reduce the effect of each other and can eliminate or intensify the effect of intoxication. Psychological reasons, that is, most patients do not like to take a lot of drugs and do not follow the medication regimen. Also, monotherapy is cheaper.

Question. Is it safe to give anticonvulsants in mild forms of epilepsy?

Answer. Yes, it is. Anticonvulsants are not recommended for some types of mild epilepsy, such as rolandic, photosensitive, and reading epilepsy. Pediatric abscess epilepsy also resolves on its own as the child gets older. But the diagnosis must be correct.

Question. What types of epilepsy are severe and can recur after a seizure has stopped?

Answer. Severe forms of epilepsy include West syndrome, Lennox-Gasto syndrome, Kojevnikov epilepsy, Rasmussen syndrome, and the like.

Question. How long should anticonvulsants be given and when should they be stopped?

Answer. There is no consensus on when to stop taking anticonvulsants. In most cases, it is recommended to take the drug for another 2 years after the last epileptic seizure. If the attacks do not recur within 2 years, the medication can be gradually reduced and stopped. In some cases, especially in symptomatic epilepsy, it is necessary to take anticonvulsants for 3-5 years. If the underlying cause of the epileptic seizure is eliminated (e.g., through surgical treatment), there is no need to take anticonvulsants for a long time. Anticonvulsants have been used for many years in Lennox-Gasto syndrome, Kojevnikov epilepsy, and Rasmussen syndrome.

Question. When can epileptic seizures start again after taking anticonvulsants completely?

Answer. Its causes are several: 1) mental and physical retardation 2) persistent focal neurological symptoms 3) long-term epileptic history 4) late start of proper treatment 5) focal epileptic seizures 6) different types of epileptic seizures if the attacks are manifested together 7) if strong changes in the EEG persist 8) other adverse factors (alcoholism, drug addiction).

Surgical treatment methods. Epileptic seizures cannot be completely stopped in almost 20% of patients, even if the anticonvulsants are chosen correctly. In such cases, surgical treatment may be required. Before sending a patient for surgery, of course, there is a consultation with qualified doctors. This is because the therapeutic methods needed for treatment may not be used enough.