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When it comes to treating people with epilepsy, the goal for everyone is different. For someone having a hundred seizures per month, it might be unrealistic to think that you can get them to a place where they’re seizure free. However, if you can reduce the seizures to 10 per month, you’ll significantly improve their cognitive abilities and quality of life. I remember a patient I had who was five years old, non-verbal and required a stroller to get around. She was having hundreds of seizures per month, despite being on multiple medications. We were able to get her seizures down to less than 20 per month with the right combination of antiepileptic drugs. When she came to my office, she was unrecognizable. She was running all over the place. She was making her needs known. She was beginning to put words together. It was so amazing to see that I didn’t even mind the trail of popcorn she left in her wake. She was a success story. Now, there are other people with epilepsy who can become seizure-free the moment you diagnose them just by putting them on one antiepileptic medication. I’ve seen patients like that also. All of a sudden their life drastically changes – their epilepsy is under control and they’re free to live their lives. In order to truly help people with epilepsy and help them live the best life possible, you have to find the right medication or medications as well as implement some lifestyle changes. Finding the right medication and dosage can be complex. Remember: you want to get rid of, or decrease someone’s seizures and do so with minimizing side effects to medication. In order to do that, there are some things that you need to know. First, you need to know the type of epilepsy they have. You see, patients with focal or localization related epilepsy respond very well to some medications while people with generalized epilepsy do better with other antiepileptic drugs. Second, you want to know about the person’s past medical history. You don’t want to give them a medication that’s going to exacerbate another problem. Third, you want to know the details about their lives, the work that they engage, in their day-to-day activities, and their plans for the future. We all know that giving some medications to women of childbearing age isn’t the best idea because of teratogenic effects, but you also don’t want people feeling tired or lethargic during their work. And you certainly don’t want to impact their cognitive abilities. As an epileptologist, I spent a lot of time switching people from one antiepileptic medication to another that suits their particular epilepsy syndrome in order to minimize their risk of seizures. I’ve also spent a lot of time making adjustments to AEDs because of side effects. While finding the right medication for someone with epilepsy can be complicated, I assure you that the time you spend finding the right medication or medications for your patient will be worth it. It will transform your patient’s lives and yours.
