Numerous medications are available to treat temporal lobe seizures. However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common.
Discuss possible side effects with your doctor when deciding about treatment options. Also ask what effect your seizure medications and other medications you take, such as oral contraceptives, may have on each other.
If you have temporal lobe seizures that don't respond to medication, you may be evaluated for surgery. For some people, surgery eliminates or greatly reduces the number of seizures.
However, as with any surgery, surgery for seizures carries risks. It may not be successful, and it can result in neurological problems. Discuss the possible risks with your neurologist and surgeon.
Surgery is generally not an option if:
- Your seizures come from a region of the brain that performs vital brain functions
- Your seizures come from more than one area
- Your seizure focus can't be identified
Preparing for surgery
Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before having surgery.
Before surgery, you'll need:
- A comprehensive evaluation
- MRI scans of your brain
- Observation of your seizures in a hospital-based monitoring unit using video recordings and EEG
Most people need to continue taking medication to help ensure that seizures don't recur. However, if surgery appears successful, medications can sometimes be reduced and occasionally discontinued.
Vagus nerve stimulation
A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck.
The device turns on and off according to an adjustable program and can be activated with a magnet. The device doesn't detect seizures. It's usually well-tolerated, but it's not a replacement for medication.
The Food and Drug Administration (FDA) has approved a device for treating seizures that don't respond to medication. The device detects seizure activity and delivers an electrical stimulation to the detected area. The device is implanted on the surface of the brain or within the brain tissue, and attached to a battery-powered generator, which is implanted in the skull, close to the brain.
Deep brain stimulation
Deep brain stimulation involves implanting electrodes into a part of the brain called the thalamus. This treatment is not currently FDA-approved for treatment of seizures. In highly selected cases, it may be beneficial in treating seizures that don't respond to medication. More study is needed.
Pregnancy and seizures
The most important thing to remember is to plan pregnancy. Women who are on medications for seizures usually are able to have healthy pregnancies. However, certain medications, such as valproic acid (Depakene), taken during pregnancy are known to increase the risk of birth defects.
Seizures pose a risk to a developing baby, so it's generally not recommended to stop medications during pregnancy. Discuss these risks with your doctor. Because pregnancy can alter medication levels, preconception planning is particularly important for women with seizures.
If you take medication for seizures and might become pregnant, taking prescription folic acid daily before you become pregnant can help prevent birth defects related to seizure medication.
The risk of birth defects is considered to be higher in women taking more than one drug. If your seizures can't be well-controlled with other medication, discuss the potential risks with your doctor.
Contraception and anti-seizure medications
Some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if you should consider other forms of contraception.
June 25, 2014
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- Benbadis SR. Localization-related (partial) epilepsy: Causes and clinical features. http://www.uptodate.com/home. Accessed April 9, 2014.
- Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm?css=print. Accessed April 9, 2014.
- Schachter SC. Surgical therapy of epilepsy in adults. http://www.uptodate.com/home. Accessed April 9, 2014.
- Tzatha E, et al. Responsive neurostimulation for the treatment of seizures that do not respond to medication. Neurology 2011;77:e79.
- FDA approves responsive stimulation therapy by Neuropace. Epilepsy Foundation. http://www.epilepsy.com/release/2014/3/fda-approves-responsive-neurostimulation-therapy-neuropace. Accessed April 23, 2014.
- Calpern CH, et al. Deep brain stimulation for epilepsy. Neurotherapeutics. 2008;5:59.
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