These episodes would last for perhaps 10-15 seconds - most of the time those around me would notice absolutely nothing, except that occasionally I may stop talking mid-sentence.

It was in the autumn of 1994 as I was studying for my "A" levels at the Hereford Sixth Form College that I stayed over at a friend's house. That night I didn't sleep at all well, and the following morning I felt very strange when the alarm clock went off. It was a little like those times when you wake up from a vivid dream and it takes a few minutes to reassure yourself that the world you've been in was only a dream. Also, my tongue hurt as it had never hurt before. I was confused, and so asked Jo who'd been sleeping in the bunk above me if she'd noticed anything during the night.

"Yes" she told me. "At one point you made quite a lot of noise and started thrashing about- but then you just went back to sleep."

I told my mum and dad about this, and they immediately recognised the signs. There was a history of epilepsy within the family, my mum's sister Veronks (she doesn't like being called "Auntie" and I don't blame her, she's far too young for that!) has had epilepsy for much of her life, whilst the stress of wartime bombing raids took their toll on my Grandmothers health. Also, at the age of 6 I'd had a few "dizzy spells". Tests at the time showed nothing unusual but a few "adult brain waves", and after a couple of months I was back to normal without any treatment.

I don't pretend to be an expert on the medical/ technical side of epilepsy, but what I write is what I understand to be the case. The brain is essentially a vast network of minute electrical contacts, and every second electricity is flowing around making and breaking these contacts - This results in all of our actions and everything else that makes us Us. In my case excessive stress or tiredness usually brought on a seizure, although with some people it is things such as televisions or flashing lights that set them off. A seizure is a result of an electricity storm within the brain, during which hundreds of "short circuits" occur and there is a complete loss of control of bodily functions.

My condition had lain dormant within me for 10 years, and was triggered (I believe) by the immense stress and pressure that I felt when I started to attend the Sixth Form College. My education at the Waldorf School had, on the whole, been an immensely positive experience. I had come to learn and understand so much- and now I was faced with an education system whereby the method seemed to be to cram as much information into your head as possible and spit it back out on paper in an exam. On top of this pressure came that from the Careers Advisors. I felt that I was expected to decide upon my entire life's vocation within the space of a few months. I was to go to university, get my degree and settle down into a 9-5 where I would stay until I reached retirement age. Having scrimped and saved for almost fifty years I would move with my wife Ethel to a little bungalow in Bournemouth where I would eventually die old and happy. Of course it doesn't really work like this, but that's what I felt was being demanded of me, and so I began to rebel.

The problems really started for me when I was put on medication to control the condition. There was always the danger of seriously hurting myself should I have a seizure anywhere but in bed, and it's common practice these days to prescribe a drug which will calm the brain when it's heading for an electrical overload. The unfortunate thing is is that you never know which of the drugs is suitable for you until you try them, and they can have very bad side effects as the first one that I tried ("Tegratol") did.

Tegratol really changed my life - although initially it just changed my personality! I became very very bad-tempered. I felt so tired, and lost my sense of humour entirely. This coincided with my first-year exams, resulting in what became a completely untenable situation. I just couldn't handle life at all. I was referred to an epilepsy specialist in Birmingham, but whenever I had an appointment he was too busy to see me. Instead, I saw nurse after nurse none of whom had a clue about my case and insisted upon hitting my knee with a hammer time after time. Thankfully, after one month or so my medication was changed to Epilim (sodium valproate), and I found that my true personality gradually re-emerged. Meanwhile, I'd had enough of the NHS (National Health Service) and enough of my mystery consultant- I simply decided to get on with my life, take the tablets I was prescribed and look no further into my condition. It turned out that the centre I had been referred to was shut down shortly after my last visit - and I'm not surprised!

I concluded that in fact it was just myself that was stopping me from realising my ambitions. I desperately wanted to leave college, and I'd long had dreams of travelling, yet it took a lot of courage to completely turn my back on my life's plan and routine as I knew it. However, with the additional craziness that the epilepsy had created I was given that final boost needed in order to write the word "Fish" a number of times on my Theology exam paper, stand up, and walk out of college - out of my formal education.

I truly feel that had I not had epilepsy I would be a very different person today. As it was, my condition led me to question the path that had been laid out before me, in addition to giving me the strength needed to challenge societies rules that I felt were binding me so strongly. Had I not had epilepsy, who knows, I may well have gone on to university and obtained a degree in a subject of marginal interest to myself. Perhaps I would have secured a position within a company that promised lots of money, for at that time that was what appealed to me most - although I'd never admit it! Would I have gained the freedom and happiness that are now such a large part of my life? Would I feel that anything was possible, or would I have just accepted that that's the way things are and I should look forward to a happy retirement?

These days I'm not even sure if I still have epilepsy - that's the thing, you can't stop the medication in case you have a seizure, but you'll only know if you don't have it by stopping the drugs anyway! I was very fortunate to see a top specialist a couple of years ago. Rather than hit me on the knee with a hammer this chap just wanted to talk. Talk about my feelings regarding my condition, my history, my hopes and my dreams. His feedback finally gave me the professional blessing that I felt I needed in order to set me free from what until that time had been a medical problem. He told me that from hearing about my history and my feelings now I probably no longer have epilepsy. He reassured me that I was perfectly capable of handling it myself, and that I could gradually reduce the dosage of my Epilim until I either reach a significantly insignificant amount, or perhaps quit altogether.

Today I am taking only a tenth of what I was originally prescribed, and I aim to come off it altogether by the end of 2003. We'll just see how it goes. I do not enjoy having to take artificial drugs, yet I accept that it's necessary. The side effects these days are more or less limited to ensuring that I'll be totally drunk on one bottle of beer. However, I have a little suspicion that they are also partially responsible for my rather crazy nature at times. I guess that none of us will know the real Joseph Tame for a few years yet.

At the end of the day I'm very thankful to have had epilepsy, it has made me feel special, and at times when I've felt weak its given me the strength to break the rules that can hold us all back. Epilepsy was the key to my freedom, and for that I am eternally grateful.

Epilepsy and I - An update - Winter 2003/2004

In February 2003, after 8 years of no seizures, my epilepsy reappeared overnight.

I was in Japan at the time, just coming out of an incredibly stressful period of my life that had lasted for about 6 months. Initially, I refused to accept that the "dizzy spells" were epilepsy. Surely, they couldn't be, not after 8 years of having no seizures whatsoever. I'd spent all of that time gradually weaning myself off the drugs, and was finally down to 200mg of Epilim Chrono a day. I'd been on that dosage for over 8 months, and was planning to give it up altogether within a few weeks.

Being in Japan, it was not so easy to get it checked out, and besides, I knew that I'd be returning to England soon where I could see my regular doctor. So, I ignored it. Within two weeks of the first "dizzy spell" I was having over 10 a day. In the March 2003 edition of The Daily Mumble I wrote:

Epilepsy and I - An update - May 2005

In May 2005, after 10 years without a tonic clonic (Grand-mal) seizure, and over two years since a minor seizure, I woke up concussed, with a bitten tongue, limbs that felt as if they'd been torn from their sockets and bleeding feet.

The following is an extract from my online diary, The Daily Mumble (15th May 2005)

- Do you have epilepsy?
- Have you had problems with Epilim or Tegratol?
- You are not alone. Please feel free to share your experiences with me.

email me

Need help?

Visit the homepage of the Britsh Epilepsy Association
for information, advice, email and phone support

If you are in the USA go to http://www.epilepsy.com/

For desciptions of major anti-epilespy drugs
and their side-effects, see bottom of page

Emails from fellow Epilepsy folks!

- I will never publish anything you send me without your permission.
All names etc have been changed for reasons of privacy

Here's Robin and Parker's tale of their experience with epilepsy:

from Jenny

The main anti-epilespy drugs and their side-effects (scroll down for drug-by-drug analysis) This information is taken from The Epicentre website http://137.172.248.46/   The conquest of epilepsy, which really began in the 1930's with the introduction of >Dilantin (Warner-Lambert), has been a triumph of modern medicine. The development of newer medications, especially Tegretol (Ciba-Geigy) and Epilim (Reckitt & Colman) has meant that epilepsy can be suppressed in most patients without serious or annoying side effects. This is not to say that every patient can be fully controlled, or that side effects do not occur. A continuing effort is being made by international pharmaceutical companies to find safer, more effective treatments for epilepsy. New drugs are not cascading onto the market however, for the high cost of research, development and marketing (About A$150 million for any new drug) is an important disincentive. How do drugs prevent seizures? Strange to say, most of the drugs used in treating epilepsy today were discovered to have anti-epileptic properties by chance. We have used these drugs with great benefit for years without really knowing how they work. However, a more systematic search for new anti-epileptic drugs is now under way, based on research progress in understanding how neurones transmit impulses to each other, and our increasing knowledge of the structure and function of the membrane which surrounds each neurone. The messages that one neurone sends to the next, meditated by releasing neurotransmitter chemicals, can either excite the neurone next in line, or can inhibit its electrical activity. The identification of gamaa-amino butyric acid (GABA for short) as an important natural inhibitory neurotransmitter led to a search for drugs which might suppress epilepsy through enhancing the activity of GABA. The drug Vigabatrin is a product of this approach. Conversely, if the activity of natural excitatory neurotransmitters could be reduced, the epileptic tendency too would be lessened. Another drug, Lamotrigine, owes its anti-epileptic properties to its ability to prevent the release of the excitatory neurotransmitter glutamine from nerve endings. Epileptic attacks should be suppressed for several reasons. Apart from prevention of injury caused by falling, biting the tongue, etc. in major attacks, frequent seizures impair memory and academic performance. The unpredictable nature of the attacks may have serious repercussions on employment and family life. Moreover, driving is not permitted until it can be shown that a person's epilepsy is under satisfactory control (more of this later). If there is some doubt about whether a "turn" was genuinely epileptic or not, or where there were special circumstances, and the EEG and other tests are found to be normal, the treating doctor might reasonably prefer to wait without giving medication, to see what happens; in this situation, commonsense in not driving for a period, and in avoiding risky situations must be exercised. However, a second seizure would strongly indicate the need to start medication without any further delay. The only effective means of treating epilepsy currently available are medication and, in a small proportion of patients in whom medication is not effective, surgery on the brain. Treating epilepsy by "natural" means alone (e.g. with herbal remedies) is ineffective and may be dangerous. What is a ketogenic diet? A ketogenic diet is very rich in lipids (fats) and oils, but low in proteins and carbohydrates. This unusually high intake of lipids and oils creates a condition in the body know as "ketosis". The metabolic shift that is created increases the seizure threshold for some. This diet is also calorie and liquid restricted. The Ketogenic diet is mainly effective in children. It requires careful preparation and strict adherence. Although it takes a significant commitment to be successful, many children have greater seizure control with this diet than with conventional (drug) therapies. Some are able to reduce or eliminate anti-seizure medications. >Careful medical supervision is essential when using this as a therapy. For further information about the Ketogenic diet, see http://www-leland.stanford.edu/group/ketodiet/, a web site that has been created by the Pediatric Neurology Division at Stanford University School of Medicine to facilitate communication between health care providers who are using the ketogenic diet to treat epilepsy. >Once started on anti-epileptic medication, never stop it unless advised to do so by a doctor. Stopping medication on one's own is likely to produce a series of major seizures, a dangerous condition. Which Drug to Use The choice of drug depends on: The type of epilepsy. Some drugs such as Epilim are active in a wide range of seizures (tonic-clonic, absence attacks, etc.) while Zarontin, for example, is active only against absence seizures. Possible side effects. For example, Dilantin tends to promote hair growth on the body and face, and should be avoided in women of dark complexion. Dilantin also seems more likely to produce slowing of thought processes including memory than the newer anticonvulsant such as Tegretol or Epilim, which do not usually produce these symptoms. Anticipation of pregnancy. All anti-epileptic drugs carry a small risk to the unborn child. We will consider this question later. Other medication. Possible interaction between the anti-epileptic drug and other medication is an important consideration. A common problem is the contraceptive pill - only Epilim appears to be free of significant interaction. Other anti-epileptic medications may make the pill less effective by speeding up its metabolism in the liver, or the pill may repay the compliment by accelerating the removal of the medication from the circulation. This does not mean that Epilim is the only anti-epileptic drug a woman may take when using the contraceptive pill but that the doctor prescribing must take this possible interaction into account. Can More Than One Drug be Used? It is generally preferable to take one drug only, since there is a risk of interaction between anti-epileptic drugs. Indeed, some neurologists go as far as saying that any patient taking more than one such drug is being mismanaged. Others disagree. There are some patients who, despite excellent blood levels of their medication, continue to have frequent seizures. The addition of a second drug may bring control which any single drug has failed to achieve. On the other hand, one can't often justify the use of a third and even a fourth drug. How Safe are Anti-epileptic Drugs in Pregnancy There is a small but definate risk of malformations of infants of mothers treated with anti-epileptic drugs during pregnancy. On the other hand, there is an undoubted risk to the unborn child if tonic-clonic seizures are not controlled, for these may cause temporary lack of oxygen. Miscarriage in early pregnancy, premature labour in more advanced pregnancy, and injury are additional risks of uncontrolled epilepsy. The best available information indicates that malformations are between two and three times more common in infants of mothers who have taken these drugs during pregnancy. As a group, epileptic women's children have a higher rate of abnormalities than the children of non-epileptic women, even if not treated with anti-epileptic drugs, but these drugs do appear to increase the rate at which abnormalities occur. The main risk is that the drugs may interfere with formation of the nervous system. The brain and spinal cord develop from cells which must first arrange themselves into a tube-like structure. This process of formation of the neural tube seems to be one which may be interefered with by drugs. Defects of the neural tube range from trivial abnormalities of the vertebrae, through to major abnormalities in which there is maldevelopment of the spinal cord with weakness of the legs and loss of bladder control. Neural tube defects include the group of malformations known as spina bifida. Of course, malformations occur in pregnancies where no drug has been taken - it's just that the anti-epileptic drugs seem to increase the risk. All three major anticonvulsant drugs (Tegretol, Epilim and Dilantin) share this risk. It is not known which of these drugs is more likely to produce abnormalities. The risk is increased if more than one anti-epileptic drug is taken. It is possible to detect major neural tube defects in the foetus by checking the level of alpha fetoprotein in the amniotic fluid surrounding the foetus, and by ultrasound examination of the unborn child. Unfortunately, these tests do not become reliable until the pregnancy is fairly advanced, (16 weeks for amniocentesis, 18 weeks for ultrasound), so that considerable emotional trauma may be inflicted on the mother in deciding whether the pregnancy should be terminated. There is some evidence that in instances where there is a family history of neural tube defect, Dilantin is safer than Tegretol or Epilim. If a woman taking anti-epileptic drugs becomes pregnant, the first question to decide is whether she needs to continue her therapy, especially if the seizures are only minor, or if the last major seizure occurred years previously. If it is decided that there is a risk of major seizures requiring continuing treatment, it is preferable to use a single drug. Whereas normally drugs may be taken twice daily, it is better to avoid blood levels from peaking too high by administering drugs (especially Epilim) more frequently (3 or 4 times a day) in smaller doses. An increase in the total daily dosage is usually required as the mother's size increases. Blood levels of anti-epileptic drugs other than Epilim should be checked regularly (at least when pregnancy is diagnosed, and at monthly intervals from the 5th month onward, and a week after delivery). There is evidence to suggest that taking folic acid supplements during pregnancy decreases the risk of neural tube defects such as spina bifida. This risk is slightly higher in women with epilepsy so there is very good reason to stress the importance of the supplement. Due to the action of some anti-epileptic drugs, women with epilepsy are recommended to take 4mg of folic acid daily, compared to the 400mcg recommended for women generally. Finally, don't forget some seizure medications can lead to failures of oral birth control pills. Monitoring Blood Levels To work effectively, blood levels of anti-epileptic medications must be maintained within a certain range. If the levels rise too high toxic symptoms (drowsiness, unsteadiness on the feet) may appear: if levels fall too low, epileptic control will be inadequate. Checking blood levels is a vital part of treatment. It is best to check both the highest and the lowest blood levels of a drug, by obtaining a blood sample just before the morning dose then sampling the blood again 2 hours after the morning dose has been taken. The frequency of blood level checking will depend on how satisfactory is the epileptic control (if the control is good, sampling at 6, or even 12 monthly intervals may suffice; if seizures are poorly controlled, blood samples may be taken daily, or many times a day, in hospital). It is possible to measure blood levels of every anticonvulsant drug, but it should be noted that in the case of Epilim (sodium valproate), blood levels do not accurately reflect the amount of drug being delivered to the neurones of the brain. With this exception, blood sampling is extremely useful in the management of epilepsy. The Anti-epileptic Drugs Tegretol (Carbamazepine) Epilum (Sodium valproate) Dilantin (Phenytoin sodium) Zarontin (Ethosuximide) Rivertril (Clonazepam) Frisium (Clobazepam) Valium (Diazepam) Mogadon (Nitrazepam) Prominal (Methylphenobarbitone) Mysoline (Primidone) Phenobarbitone Ospolot (Suthiame) Gabapentin Progabide Vigabatrin Lamotrigine Topiramate Gabitril >NEW Anti-epileptic drugs are also known as "anticonvulsant", since they prevent convulsions. We prefer to call them anti-epileptic, because, as we have seen, not all forms of epilepsy involve convulsions. Let us briefly survey the anti-epileptic drugs which are in use at the present time. TEGRETOL Carbamazepine, Ciba-Geigy Ltd This is a powerful anti-epileptic drug with a wide range of activity. It is available as white tablets of two strengths (100 mg and 200 mg), and is usually given twice a day (say after breakfast, and then after the evening meal, around 12 hours later). An average sized adult usually requires between one and two tablets (200 mg size, twice a day). If the dose is too high, the patient may appear to be "drunk", with drowsiness, lack of co-ordination in walking, etc. Reduction of the dose, based on blood levels, is all that is required. Side effects (unwanted symptoms occurring in someone whose levels are correct) are common in the first few days or week or two, especially giddiness and light headedness, mild nausea, and dryness of the mouth. These usually disappear within a few days. They are less likely to occur if Tegretol is introduced in a gradual way. A measles-like rash sometimes occurs during Tegretol treatment, and in this event, Tegretol must be replaced by another anti-epileptic drug. Serious side effects are fortunately rare. They include jaundice due to liver involvement, and lowering of the white cell count of the blood, resulting in persistent ulceration of the throat and mouth. The manufacturers recommend that blood tests (full blood count, tests of liver and kidney function) be carried out before starting Tegretol, and that the full blood count be repeated weekly for the first month of treatment, then monthly for the first year. In practice, Tegretol side effects are usually mild, and disappear within the first week or two. It is arguably the most powerful and useful anti-epileptic drug currently available. [note from joseph: I note that there is an absence here of any information on the very bad side effects such as a complete change of personality that some people on tegratol (like me!)can get!] Back to the anti-epileptic drugs menu EPILIM Sodium valproate, Reckitt & Colman Pharmaceuticals This is another extremely useful drug with a wide range of anti-epileptic activity. It is thought to act by increasing the brain's levels of the inhibitory neurotransmitter, GABA. Epilim is presented as lilac colored tablets of 200 mg and 500 mg strength. These should be swallowed whole. It is also available as crushable tablets of 100 mg strength, and as syrup of 200 mg/5ml strength, and sugar free liquid of similar strength. It is usual to give Epilim twice a day, with meals, with roughly 12 hours between doses. Since blood levels of Epilim are unreliable as a guide, adjustment of the dosage is made according to the patient's body weight, and the adequacy of seizure control. The usual dose range is 20 to 30 mg/kg body weight/24 hours. Mild side effects, especially nausea and diarrhea in the first few days, are common. A fine tremor of the hands is often noticed in patients taking Epilim over the long term. Weight gain and loss of hair (usually reversible) can also occur. Very rarely, Epilim may produce acute liver disease, and there have been instances of acute liver failure, some fatal. Small children and infants with serious underlying medical conditions are most at risk. The question of the safety of Epilim has received careful study by Australian health authorities, and its continued use has been endorsed, for it is in practice a widely used, effective, and well tolerated medication. It is suggested that Epilim be avoided in patients with a history of liver disease, and that blood tests to check liver function and the level of platelets in the blood (sometimes reduced by Epilim) be carried out before starting treatment, and repeated after one month's treatment, and thereafter at intervals of not more than 6 months. Minor abnormalities of liver function are common in patients taking most anti-epileptic drugs, but evidence of increasing abnormality would require substitution of Epilim. Symptoms of this rare complication of liver failure include severe nausea persistent abnormal pain, jaundice (yellowish discoloration of the skin), severe nausea, weakness and tiredness, and swelling of the face. Any of these symptoms should be reported to the treating doctor. Back to the anti-epileptic drugs menu DILANTIN Phenytoin sodium, Warner-Lambert This is the oldest of the effective major anti-epileptic drugs. It is still one of the most potent in preventing major seizures of tonic-clonic and other types, but its troublesome side effects have meant that the other, newer drugs such as Tegretol and Epilim are usually selected instead. Dilantin has a powerful action in controlling seizures, and is very useful as an additional drug where seizures cannot be controlled by one drug alone, or when it is not intended to continue treatment over a very long period (for example, when anti-epileptic drugs are given routinely for a year or two after brain surgery). Dilantin is presented in capsule form (100mg, orange and white capsules, 30mg, all white capsules), in liquid form (30 mg/5ml strength for children, 100 mg/5ml. "Dilantin Forte Suspension" for adults), and as chewable tablets for children (50 mg, "Infatabs") The drug is slowly released, so that theoretically it would be possible to take the medication as a dingle daily dose; however, people's memories being what they are, it is recommended that the medication be taken twice a day (e.g. after breakfast, and after the evening meal as a routine). The usual dose for an adult of average size is 3 to 4 capsules of 100 mg strength per 24 hours. Dilantin overdose produces symptoms similar to drunkenness, with drowsiness, unsteadiness on the feet, etc. Blood levels of Dilantin will indicate the true picture. Short term side effects of Dilantin are not usually a problem, but side effects developing gradually over a period of years do present serious objections to its long term use, especially as other effective anti-epileptic drugs which do not have these problems are now available. These long-term side effects of Dilantin are the growth of hair on the face, arms and legs, especially in female patients of dark complexion, unhealthy overgrowth of the gums, with a tendency for them to bleed, and mental sluggishness and loss of memory. If Dilantin is to be taken over a long period, special attention should be paid to brushing the teeth and generally maintaining good oral hygiene. An uncommon complication of Dilantin therapy is the development of an allergic measles like rash, which requires substitution of the drug with another. Back to the anti-epileptic drugs menu ZARONTIN Ethisyxunudem Parke Davis Pty Ltd This drug is effective in controlling one form of epilepsy only, namely absence seizures (formerly known as "petit mal"). As this form of epilepsy begins in childhood, Zarontin is made available as a red syrup (250 mg/5 ml) and as capsules (250 mg). The dose required will vary according to blood levels and body weight, the average dose for a child aged 6 years being one capsule, 2 or 3 times a day. Side effects are not common, but include nausea and digestive upset, drowsiness and sleep disturbance. Back to the anti-epileptic drugs menu Benzodiazepine Drugs These drugs have sedative and anti-anxiety properties as well as being anti-epileptic. They are in fact only fairly week drugs against epilepsy, while their tendency to produce sedation and dependency greatly limit their usefulness. In practice, these drugs should never be used as a first choice, but rather reserved for those situations where epilepsy remains uncontrolled despite treatment with adequate doses of other anti-epileptic drugs. The benzodiazepine drugs include: RIVOTRIL (Clonazepam, Roche Products Pty Ltd) FRISIUM (Clobazepam, Hoescht Australia Ltd) VALIUM (Diazepam, Roche Products Pty Ltd) MOGODON (Nitrazepam, Roche Products Pty Ltd) The main side effects of these drugs are sedation and drowsiness in the daytime. There is a risk of producing drug dependency. Also, patients may experience various unpleasant side effects, such as restlessness, sleep disturbances, etc. when these drugs are withdrawn after a long period of administration. Back to the anti-epileptic drugs menu Barbiturate Drugs These drugs were widely used in the 1950's and 1960's, but are now considered to be obsolete. They are not very effective in suppressing seizures, but they frequently cause slowing of the intellect and depression. Withdrawing these medications can be extremely traumatic, with anxiety, restlessness, tremors, insomnia, and an increased risk of convulsions being prominent as the drug leaves the system. An effort should be made to change every patient still taking these drugs over to one of the newer anti-epileptic medications, difficult as this might be. Barbiturate anti-epileptic drugs still available include: PROMINAL (Methylphenobarbitone, Winthrop Laboratories) MYSOLINE (Primidone, I.C.I. Australia Pty Ltd) PHENOBARBITONE (various manufacturers) Back to the anti-epileptic drugs menu Other Drugs OSPOLOT (Sulthiame, Bayer Pharmaceuticals) This drug may have a special value in controlling epilepsy in intellectually disabled, aggressive children. It is not a very effective anti-epileptic, and is not widely used. Back to the anti-epileptic drugs menu The Newest Anti-epileptic Drugs These drugs are the outcome of research aimed at suppressing seizures by either increasing inhibition (through enhancing the activity of the natural inhibitory neurotransmitter GABA, or simulating its action); or, alternatively, reducing the effectiveness of natural excitatory neurotransmitters, such as glutamate. Back to the anti-epileptic drugs menu Drugs Acting Through Increasing Inhibition GABAPENTIN and PROGABIDE were the first drugs of this type to be developed. They are active against a wide spectrum of seizures. VIGABATRIN was licensed in the UK in 1989 and appears to be a very useful medication in treating various forms of epilepsy that have not responded to other drugs. Early reports of degenerative changes in neurones of animals treated with Vigabatrin led to the most stringent appraisal of its safety in humans, but no similar effect has so far been reported in man. Back to the anti-epileptic drugs menu Drugs Which Reduce Excitation of Neurones LAMOTRIGINE partly blocks the release of the excitatory neurotransmitter glutamate from nerve endings, and reduces the influx of sodium in the recipient neurone (this influx of sodium is vital to nervous transmission). It too appears to have a wide range of anti-epileptic activity. Allergic reactions, especially skin rashes, are relatively common. It is used as an additional treatment in patients with partial seizures with or without secondary generalization, where seizures have not been controlled by other anticonvulsant drugs. TOPIRAMATE has been shown to significantly reduce the frequency of epileptic seizures, including refractory partial seizures. It appears to help balance electrical activity in the brain while blocking other substances that increase activity. For further information, see the Topamax Information Centre. Back to the anti-epileptic drugs menu Drugs that affect the availability of gamma aminobutyric acid (GABA) GABITRIL (tiagabine hydrochloride) is one of a new class of compounds that affects the availability in the brain of gamma aminobutyric acid (GABA), a naturally occurring chemical that is thought to suppress the abnormal, repetitive pattern of central nervous system activity that can lead to seizures. Gabitril appears to work by inhibiting neuronal reuptake of GABA, thereby prolonging the amount of time it is available at receptor sites. It is used as an additional treatment in patients with partial seizures (adults and children 12 years and older). Gabitril is licensed from Novo Nordisk A/S of Denmark and has cleared regulatory review in 15 countries, including Australia, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxemburg, Portugal, Spain, and Switzerland. In the USA Gabitril became available by prescription in pharmacies in October 1997. For further information, see the press release from Abbott Laboratories. Surgery for Epilepsy The idea of treating epilepsy by surgery is not new; the first operation for epilepsy was carried out in 1886. Over the years, improvements in the safety of neurosurgery saw an expansion of the surgical approach, from simple operations to remove superficial, small localized abnormalities of the brain, to complex operations which included severing nervous connections. Some of the operations, for example, those in which the major connection between the two hemispheres of the brain was cut, had important adverse effects on the brain's normal functioning; when this was realized, surgery fell from favor, and the flood of operations that were carried out in the 1950's and 1960's was reduced to a trickle. Interest in surgery has been revived in recent years, for it is now realized that it does have and important part to play in a small minority of patients, namely those who have a single solitary epilepsy-producing abnormality of the brain, situated in an area where removal does not leave any significant defect in the brain's function. Even in these patients, operation is contemplated only when satisfactory control cannot be achieved with medication. To determine that a patient does indeed have only one area of the brain giving rise to epilepsy, new nuclear medical techniques (SPECT and PET scanning) are used to supplement information from special EEG techniques including EEG telemetry, sleep studies, and recording from pharyngeal or sphenoidal electrodes as appropriate. Special units at a small number of Australian teaching hospitals have been set up with facilities to evaluate patients who are candidates for surgery. Monitoring over several days may be required. It is no longer necessary to monitor the EEG through electrodes implanted in the brain, a technique which was used until recently. Surgery is clearly inappropriate for patients who suffer from generalized epilepsy where there is no single area which can be identified as the source of the seizures. It carries increased risk when the dominant hemisphere of the brain is involved (the left hemisphere in a right-handed person). It should be said, however, that where great care is taken in the selection process, the results of surgery can be excellent, and in a sense, it is the only way we have of "curing" epilepsy at the present time. Because the selection criteria are strict, surgical treatment would not be appropriate for more than 1% of epileptic patients. First Aid for Seizures The appropriate behavior for helping someone who has a seizure depends on the type of seizure. While a person experiencing a tonic-clonic seizure may require some first aid, in most cases there is little that can be done. Tonic-Clonic (Grand Mal) This type of seizure is often the most dramatic and frightening, but it is important to realize that a person undergoing an epileptic seizure is usually unconscious and feels no pain. The seizure usually lasts only a few minutes, and the person does not need medical care. These simple procedures should be followed: Keep calm. You cannot stop a seizure once it has started. Let the seizure run its course. Do not try to revive the person. Ease the person to the floor and loosen and tight clothing. Try to remove any hard, sharp, or hot objects that might injure the person. It may be necessary to place a cushion or soft item under their head. Do NOT put anything in the person's mouth. As the person relaxes after a fit, turn him gently onto his stomach with the face to one side and the head extended so that the saliva can flow from the mouth. Its important to make sure that he can breathe freely. After resting most people carry on as before. If the person is not at home and still seems groggy, weak, or confused, it may be better to accompany him home. In the case of a child having a seizure, contact the parent or guardian. If the person undergoes a series of convulsions, with each successive one occurring before he or she has fully recovered consciousness, or a single seizure lasting longer than 10 minutes, you should immediately seek medical assistance. Absence (Petit Mal) No first aid is required. Complex-Partial (Psychomotor or Temporal Lobe) Do NOT restrain the person. Protect him or her by moving sharp or hot objects away. If wandering occurs, stay with the person and talk quietly. Simple-Partial (Focal) No first aid is required.

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