Help When Epilepsy Treatment Doesn't Work
What Is Refractory Epilepsy?
If your doctor says you have refractory epilepsy, it means that medicine isn't bringing your seizures under control. You might hear the condition called by some other names, such as uncontrolled, intractable, or drug-resistant epilepsy.
Your doctor can try certain things to help keep your seizures under better control. For instance, they might try different combinations of drugs or a special diet.
Your doctor may also put a device under your skin that sends electrical signals to one of your nerves, called the vagus nerve. This may cut the number of seizures you get. A Neuropace device is a reactive neurostimulator that detects seizures and shocks the brain to stop them.
Surgery that removes a part of the brain that causes your seizures may also be an option. With any of these treatments, you may still need to take epilepsy medicine throughout your life.
It's natural to feel anxious when the doctor tells you your epilepsy isn't getting better with the medicine you're taking. You don't have to go through it alone, though. It's important to reach out to family and friends to get the emotional support you need. You might also want to join a support group, so you can talk with other people who are going through the same things you are.
Causes
Doctors don’t know why some people have refractory epilepsy and others don't. You can have refractory epilepsy as an adult, or your child might have it. About 1 in 3 people with epilepsy will develop it.
Symptoms
The symptoms of refractory epilepsy are seizures despite taking anti-seizure medication. Your seizures could take different forms and last from a few seconds to a few minutes.
You may have convulsions, which means you can't stop your body from shaking.
When you have a seizure, you may also:
- Black out
- Lose control of your bowels or bladder
- Stare into space
- Fall down suddenly
- Get stiff muscles
- Bite your tongue
Getting a Diagnosis
Your doctor has several ways to diagnose refractory epilepsy. They may ask you questions such as:
- How often do you have seizures?
- Do you ever skip doses of your medicine?
- Does epilepsy run in your family?
- Do you still have seizures after taking medicine?
Your doctor may also give you a test called an electroencephalogram. To do this, they'll place metal discs called electrodes on your scalp that measure brain activity.
Questions for Your Doctor
- What might be causing my seizures?
- Which tests are needed to diagnose refractory epilepsy?
- Should I see an epilepsy specialist?
- What treatments are available for refractory epilepsy?
- What precautions should I take to avoid getting injured during a seizure?
- Are there any limits on my activities?
Treatment
Medications. Your doctor may take a second look at the drugs you're taking. They may suggest another medicine, either alone or combined with other drugs, to see if it helps you have fewer seizures.
Many drugs can treat epilepsy, including:
- Brivaracetam (Briviact)
- Cannabidiol (Epidiolex)
- Carbamazepine (Carbatrol, Tegretol)
- Cenobamate (Xcopri)
- Clobazam (Sympazan)
- Divalproex (Depakote)
- Dilantin (Phenytek)
- Eslicarbazepine (Aptiom)
- Felbamate (Felbatol)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Oxcarbazepine (Trileptal)
- Perampanel (Fycompa)
- Potiga (Ezogabine)
- Primidone (Mysoline)
- Rufinamide (Banzel)
- Tiagabine (Gabitril)
- Topiramate (Topamax)
- Vigabatrin (Sabril)
- Zonisamide (Zonegram)
Surgery. If you still have seizures after trying two or three anti-epilepsy drugs, your doctor might recommend brain surgery.
It can help a lot if your epilepsy only affects one side of your brain. Doctors call that refractory partial epilepsy.
A surgeon removes the area of your brain that's responsible for your seizures.
It's natural to worry about brain surgery and to wonder if it will affect the way you think or if you'll seem like a different person afterward. Talk with your doctor about what to expect if you choose the surgery or if you don't, so you can weigh the risks and benefits. A lot of people who have the surgery say that getting free of seizures -- or at least making them less common and less intense -- makes them feel much better.
The surgeon usually operates on an area of your head that's behind your hairline, so you won't have noticeable scars.
After it's done, you'll probably need to stay in an intensive care unit of the hospital for a few days. After that, you'll move to a regular hospital room, where you may need to stay for up to 2 weeks.
You should take it easy for a while after you get back home, but you'll probably be able to return to a normal routine in 1 to 3 months. Even with the surgery, you might need to take seizure medication for a few years. You might need to stay on the drugs for the rest of your life.
Talk to your doctor about any side effects you might have from the surgery. You can ask them to put you in touch with other people who've had the surgery, so you can better understand what to expect.
Diet. The ketogenic diet helps some people with epilepsy. It's a high-fat, low-protein, no carb diet. You have to start it in a specific way and follow it strictly, so you need a doctor's supervision.
Taking Care of Yourself
Stress can sometimes trigger seizures. Talking to a counselor is a great way to find solutions to manage your stress.
Try going to a support group, too. You can talk with people who know what you're going through and who give advice from their own experience.
What to Expect
Even though you have refractory epilepsy, it's still possible to get your seizures under control. It may be a matter of switching to a different treatment.
Your doctor may find a different drug combination that helps. Getting electrical stimulation of the vagus nerve means fewer seizures for about 40% of people who try it. And if a brain surgeon can remove the part of the brain that's causing seizures, the seizures may stop, or at least happen less often and become less intense.
Getting Support
As you are finding out what works best, you'll need a strong network of family and friends who can offer emotional support, especially if your seizures prove hard to control. Having a trusted person to listen to you can be a great comfort when you're going through something tough.
Ask your doctor for information on support groups in your area. You can also find out about support groups by going to the website of the Epilepsy Foundation.
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