Dr. Michael Privitera advises that you work with your physician to weigh medication options, manage seizure triggers and get educated.
EpilepsyAdvocate: What’s the first step a person should take after getting a diagnosis of partial-onset seizures?
Dr. Michael Privitera: “The first decision after experiencing a single seizure is whether to begin anti-epilepsy medication. In some people the answer is straightforward—there are positive findings on an EEG or MRI, or there’s a family history to indicate a risk of future seizures. However, for someone with negative findings and no history, there is sometimes more discussion. The main question is often the same: Do the risks of another seizure outweigh medication risks? It’s a good idea to involve a neurologist in that decision. The most important thing is feeling that the physician is knowledgeable and is answering your questions.”
EA: Say your doctor decides that medication is the right path. How do you make sure it’s the right one for you?
Privitera: “Your physician needs to ensure that the drug is well matched to you in terms of the seizure type you have and side effects. Some medications can cause cognitive slowing or drowsiness; if you’re in a job where this would be a major problem, then you should discuss another drug. Many people with epilepsy also have issues with depression, and there are anti-seizure drugs that can improve this or worsen it. Look at the entire safety profile of a drug and speak to your physician about the potential impact of your lifestyle.”
EA: Once patients settle on a treatment, what are their biggest concerns?
Privitera: “Driving, driving and driving. Laws vary by state, but most states say that you need to be seizure-free for three months after an initial seizure before you may drive. The best way to get back to driving is by working with your physician and caregivers on taking their medications and by complying with the state’s driving laws. Exploring other transportation options is also important in case driving is not a viable option.”
EA: What lifestyle changes can help with seizure control?
Privitera: “Getting enough sleep is big; sleep deprivation is a known seizure trigger, as is stress, which is the most commonly reported trigger. Exercise helps control stress. Combining exercise and stress reduction techniques such as yoga, meditation, or one we’re studying now, progressive muscle relaxation, can help even more. Some people respond better to more cognitive interventions like psychotherapy, while others get more relief from physical things like yoga. People with a history of anxiety and depression often are more sensitive to stress-induced seizures, so managing those issues is especially important for them. Avoid or minimize alcohol.”
EA: Does medication typically have to be taken indefinitely?
Privitera: “We generally look for three to five years of seizure control before discussing whether to discontinue medication. At that point I often say to patients, ‘Let’s look realistically at this. If you were to have a seizure, how would that affect your quality of life? How is being on the medication affecting your quality of life?’ We weigh the options.”
If you or someone you know has recently experienced a seizure, talk to a doctor.
Written exclusively for EpilepsyAdvocate.com