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Continuing seizures (despite medication)

There are many people in whom medications have never stopped seizures without difficult side effects. These patients need more evaluation. Continued seizures place the person at risk for memory loss as well as difficulties in the workplace, at school and in relationships. Electroencephalography (EEG), or brainwave recordings, while seizures are occurring must be conducted to make sure that the diagnosis is correct.

Epilepsy centers that record continuing seizures find that 25% of patients do not have seizures after all, which is why their medications for seizures didn't work. These recordings are difficult to obtain early in the diagnostic process due to the infrequency of seizures. When medications fail, this evaluation is the next step.

How do I know if my continued seizures are serious?

Often patients are faced with whether or not to be concerned that they continue to have seizures. Questionnaires have shown they often don't report their seizures to their doctors. Some patients may be afraid of an unpleasant diagnosis or discovering what the future may bring; others may fear additional side effects from treatment or be concerned that no answer can be found for their medical problem. However, continued seizures are a serious issue. People with seizures at least monthly have more injuries, less employment and lower self-esteem. Continued seizures are definitely serious and should be checked out.

Why haven't medications worked?

Treatments for epilepsy, such as phenobarbitol, introduced in 1912, worked in about half the patients, and most people were happy with any improvement. The question with newer medications was whether there was a best choice. A study commissioned by the Veterans Administration examined four epilepsy drugs. The newest drug in the 1970s, carbamazepine, appeared to be the most effective. But after one year of treatment, only about 50% of patients were still seizure-free, and less than 50% were seizure-free for many of the other drugs. This discouraging result was blamed on the nature of the study, and it took 25 years until a second large study in the United Kingdom showed a similar result.

In fact, the second drug tried after the initial medication produced seizure freedom in only 14%, which was similar to the VA study results. Few if any patients in the UK study benefited from a third drug or drug combination. Some seizures appear to resist medication treatment. These seizures are either so strong or different that we just don't get them to stop. Sometimes the cause of continued seizures is that the condition being treated is not what we thought it was. A different seizure type or some other condition resembling seizures will not respond to medications because it wasn't the illness we thought it was. There are other tests that can be helpful in the situation where seizures continue.