Epilepsy - Long-Term Treatment

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Indications for Surgery

Surgery is an option for appropriate patients who do not respond to medications and have epilepsy in the temporal lobe (where most complex partial seizures occur). Younger people are preferred candidates for surgery because older people have more difficulty with rehabilitation.

In general, about 75% of appropriate patients can expect at least partial remission at experienced centers, with some centers reporting even better results. Temporal lobe surgery may even improve quality of life, prolong survival, and help prevent sudden deaths associated with epilepsy. Yet despite these benefits, and the significant chance for failure after trying four or five drugs, doctors now wait an average of 15 - 19 years before they consider a surgical alternative.

Treatment for Special Population Groups

Treatment of Specific Seizure Syndromes in Infants and Small Children.

• Lennox-Gastaut. The newer drugs, felbamate, lamotrigine, and topiramate, are useful in treating this syndrome in children 2 years and older. (Note: Serious rash is more common in young children with lamotrigine than it is in adults.)
• Infantile spasms. Infantile spasms are treated with vigabatrin, adrenocorticotropic hormone (ACTH), or valproate. Some experts recommend that vigabatrin be given first and ACTH administered 10 - 14 days later. In one small study, no infants who were given this combination relapsed after 4 months. Newer drugs may also be effective for this problem, but their effects on small children are not yet wholly known.
• Acute tonic-clonic convulsions and convulsive status epilepticus. Intravenous diazepam, a drug known as a benzodiazepine, is the first choice. Rectal administration of benzodiazepines, either diazepam or lorazepam, may also be beneficial. Some evidence suggests that rectal administration of lorazepam is safer and more effective than diazepam, but more research is needed.
• Prolonged febrile seizures. Prolonged febrile seizures in infants and small children may be treated with intravenous benzodiazepines, usually diazepam. Other drugs under investigation include nasally administered midazolam (a newer benzodiazepine). In one study, it was effective for managing febrile seizures in children. It is absorbed quickly and is as safe as diazepam. With the proper instruction, it can also be administered by caregivers at home.