The most important part of the evaluation is the
electroencephalogram (EEG) because it is the only test that
directly detects electrical activity in the brain (seizures are
defined by abnormal electrical activity in the brain). During an
EEG, electrodes (small metal disks) are attached to specific
locations on your head. The electrodes are also attached to a
monitor to record the brain's electrical activity. The EEG is
useful to confirm a diagnosis of epilepsy and to determine the type
of epilepsy.
The routine EEG procedure takes about 90 minutes, but a routine
EEG records only about 20 minutes of brain waves. Because this is
such a short amount of time, the results of routine EEG studies are
often normal, even in people known to have epilepsy. Therefore,
prolonged EEG monitoring might be necessary.
Prolonged EEG-video monitoring is an even better diagnostic
method. During this type of monitoring, an EEG monitors the brain's
activity and cameras videotape body movements and behavior during a
seizure. Prolonged monitoring often requires the patient to spend
time in a special hospital facility for several days. Prolonged
EEG-video monitoring is sometimes required to definitively diagnose
epilepsy.
5. How is epilepsy treated?
The majority of epileptic seizures are controlled with drug
therapy, particularly anti-convulsant drugs. The type of treatment
prescribed will depend on several factors, including the type of
epilepsy (focal/partial versus generalized), the frequency and
severity of the seizures, the person's age, overall health, and
medical history. An accurate diagnosis of the type of epilepsy (not
just the type of seizure, since most seizure types occur in
different types of epilepsy) is critical to choosing the best
treatment.
There are many drugs available to treat epilepsy, including:
- Phenytoin (Dilantin® or
Phenytek®)
- Phenobarbital
- Carbamazepine (Tegretol® or
Carbatrol®)
- Primidone (Mysoline®)
- Ethosuximide (Zarontin®)
- Valproic acid (Depakene®)
- Divalproex (Depakote®, Depakote
ER®)
- Diazepam (Valium®) and related medications such
as clonazepam (Klonopin®), and clorazepate
(Tranxene®)
- Felbamate (Felbatol®)
- Gabapentin (Neuronti-n®)
- Lamotrigine (Lamictal®)
- Tiagabine (Gabitril®)
- Topiramate (Topamax®)
- Levetiracetam (Keppra®)
- Zonisamide (Zonegran®)
- Pregabalin (Lyrica®)
In general, for a given type of epilepsy there are only minor
differences among appropriate drugs. The choice is most often based
on other factors specific to each patient, such as which side
effects can be tolerated and which delivery method is
acceptable.
Although the different types of epilepsy vary greatly, in
general, medicines can control seizures in about 70 percent of
epilepsy patients.