Epilepsy Patient Newsletter February 2020

by Dr. Kartik Sivaraaman, MD

Our brain is the most complicated structure that exists in nature, a product of millions of years of evolution. A seizure in the brain can be compared to a short circuit in our electronic gadgets. There is a temporary loss of function and it takes some time thereafter for the brain to recover. Your brain needs to restart!

The field of epilepsy has seen great strides in the last couple of decades. We currently have over 20 drugs for treatment of epilepsy. The mechanism by which these drugs produce their effects varies but in general they attempt to either stop or decrease the spread of abnormal electricity in the electrical circuits of the brain. The currently available antiepileptic drugs are in general well tolerated and appear to have a favorable adverse effect profile. Of these, the newer ones have an even better profile. Despite the benefits of these newer drugs, the older generation antiepileptic drugs such as phenytoin, phenobarbital, and carbamazepine are still in frequent use all over the world, in part due to their efficacy but mostly due to easy availability and cost. In addition, patients who have had their seizures well controlled on these medications are reluctant to change them (No one likes to fix something that ain’t broken!)

One important thing to consider when being treated with antiepileptic drugs is the duration of treatment. Most patients are on treatment at least for a couple of years and hence adverse effects, even if minimal, can be cumulative. It is important to monitor and treat these on a regular basis. While it is difficult to discuss the individual adverse effects in an article like this, there is a common theme that is worthy of mention. Many of the antiepileptic drugs, especially the older generation medications, appear to stimulate the liver. Meaning, the liver becomes more and more efficient at metabolizing and clearing the medication, often necessitating an increase in the dosage over time. This is kind of the same process that causes the liver of an alcoholic to chew away alcohol fast, therefore increasing their tolerance to alcohol, requiring more and more to achieve the desired effect.

Unfortunately, the above-mentioned process has other unintended consequences. Some essential bodily activities also become affected. Your vitamin D levels start to run low causing bones to become weak and fracture-prone. Cholesterol levels tend to rise. Other markers of cardiovascular risk have also been shown to increase. Considering that the second peak of epilepsy happens later in life, the consequences of the above adverse effects are even more concerning. This however does not immediately mean discontinuation of medications. A regular monitoring of the above coupled with supplementation of vitamins can go a long way at preventing adverse consequences. Your bone health can also be assessed with a DEXA scan. When feasible, a consideration for a switch to a medication with a better side effect profile can be attempted. In conjunction with a healthy lifestyle, the above-mentioned factors can greatly improve outcomes.

The following lifestyle changes, along with right medications, should foster good outcomes in the long run:

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Keep moving.

The American College of Sports Medicine recommends 150 minutes (2.5 hours) of physical activity each week.

Eat smart.

Adopt a sustainable, healthy eating pattern that focuses on whole foods rather than individual nutrient groups.

Sleep right.

Sleep quality can have an effect on seizure frequency.