Epilepsy Treatment in Indore

Epilepsy is a chronic neurological disorder described by a tendency to have recurrent, unprovoked seizures due to abnormal electrical activity in the brain.

Treatment generally concentrates on the patient's quality of life, seizure control, and complication prevention.

Treatment approaches include:

Anti-seizure medicines, also known as ASMs/AEDs

Addressing underlying causes, if identifiable

Lifestyle and safety strategies

Surgical options for drug-resistant epilepsy

Neuromodulation therapies

Dietary therapies

Emergency seizure management

Long-term monitoring and follow-up

1. Anti-Seizure Medications (Primary Treatment)

For most patients, ASMs will be the first-line treatments, which work to dampen the abnormal electrical activity of the brain.

Goals of medication therapy

Achieve seizure freedom

Minimise adverse effects

Use the lowest effective dose

Improve daily functioning

Commonly used ASMs include :

(Examples for general education)

Valproate

Levetiracetam

Lamotrigine

Carbamazepine

Oxcarbazepine

Topiramate

Zonisamide

Phenytoin

Lacosamide

Clobazam

Ethosuximide, especially for absence seizures

How medications are chosen

Selection depends on:

Types of seizures: focal, generalised, absence, etc.

Age and sex

Other medical conditions

Possible side effects

Drug interactions

Pregnancy considerations

Principles of treatment

Start low, go slow

Check levels for certain drugs (e.g., valproate, phenytoin)

Avoid abrupt cessation (seizure risk increases)

2. Treatment of Underlying or Contributing Causes

Sometimes, epilepsy is a secondary symptom of another condition. Treating the cause may reduce or eliminate seizures.

Possible causes include:

Brain infections

Tumors

Structural abnormalities

Trauma

Metabolic disorders

Management may involve:

Treating infection

Surgery for tumours

Correcting metabolic problems

Managing stroke or traumatic injury

3. Lifestyle, Behavioural & Safety Management

These strategies reduce seizure triggers and improve safety.

Common approaches:

Maintaining regular sleep

Stress reduction

Avoiding alcohol or recreational drugs

Hydrating yourself

Avoiding flickering lights for photosensitive epilepsy

Adherence to medications

Safety measures

Avoidance of heights or solitary, unguarded swimming

Showering instead of bathing to avoid drowning

Seizure-proofing living spaces

These depend on the seizure type and severity.

4. Surgical Treatments (For Drug-Resistant Epilepsy)

About one-third of patients do not achieve control with medications alone.

The patient may be considered for surgery if two or more medications are appropriate and fail.

Common surgical options include:

1. Resective Surgery

Resection of the seizure-producing brain region.

Examples:

Temporal lobectomy

Lesionectomy: removal of tumours or malformations

This has enabled many patients to achieve complete seizure freedom.

2. Disconnective Surgery

Interrupts the seizure spread pathways.

Examples:

Corpus callosotomy

3. Hemispherectomy (rare, specialised cases)

Used primarily in children with severe, one-sided brain disorders.

5. Neuromodulation therapies

Used when surgery is not an option or as part of combination therapy.

1. Vagus Nerve Stimulation (VNS)

Implanted device sends electrical signals to the vagus nerve → reduces seizure frequency.

2. Responsive Neurostimulation (RNS)

Abnormal electrical activity is detected and disrupted by a device implanted in the brain.

3. Deep Brain Stimulation (DBS)

Electrodes stimulate specific regions within the brain (e.g., the anterior nucleus of the thalamus).

These do not usually eliminate seizures but can considerably reduce them.

6. Dietary Therapies

Dietary treatment is particularly useful in children and certain adults with drug-resistant epilepsy.

Common dietary options:

1. Ketogenic Diet

high fat, low carbohydrate

This produces ketones that assist in stabilising brain activity.

2. Modified Atkins Diet (MAD)

Less restrictive than classic keto; easier long-term use.

3. Low Glycemic Index Treatment (LGIT)

These diets require supervision by clinicians and dietitians.

7. Emergency Management of Seizures

Acute treatments (used by medical teams or caregivers)

Benzodiazepines

(e.g., midazolam, diazepam)

Used to prevent:

prolonged seizures

seizure clusters

status epilepticus life-threatening >5 minutes

These can include the following protocols:

IV medications in hospitals

Nasal or rectal formulations for home rescue

8. Long-Term Monitoring & Follow-Up

Epilepsy is a condition that needs to be managed continuously.

Regular monitoring includes:

Medication adjustments

Blood tests for specific drugs

EEGs, and imaging as required

Screening for mood disorders (anxiety, depression, common)

Sleep assessment

Lifestyle, pregnancy, and driving safety counselling

Quality of life considerations

Education and employment support

Mental health support, Social and safety planning 9. Prognosis Outcomes differ according to: Type and cause of epilepsy, Response to medications, Early management, Age, Presence of other neurological conditions. With appropriate treatment, many patients will experience long-term seizure control.