Epilepsy

Disease Description (Causes and Symptoms)

• Definition summary: Epilepsy is a chronic neurological disorder in which recurrent seizures (loss of consciousness, motor symptoms, sensory or behavioral changes, etc.) occur due to temporary excessive synchronous discharges of cerebral nerve cells.
• Pathophysiology: The key mechanism is excessive regional or generalized synchronization of the brain's normal electrical activity, causing abnormal electrical discharges. Depending on the location of the lesion, it may present as focal seizures (localized symptoms) or generalized seizures (including generalized tonic-clonic seizures).
• Main causes (examples by age)
  • Infancy: Perinatal brain injury, congenital malformations, metabolic diseases, hypocalcemia/hypoglycemia, etc.
  • Infancy and childhood: Febrile seizures, infections (meningitis/encephalitis), trauma
  • School age to young adulthood: Idiopathic (unknown cause), trauma, tumors, infections
  • Older adulthood: Stroke, tumors, degenerative diseases
• Main symptoms
  • Reduced or lost consciousness, generalized or focal convulsions, eyelid or hand tremors, abnormal behavior or movements, aura and postictal confusion, etc.
  • Symptoms vary greatly depending on the brain area where the seizure occurs and the extent of its spread

Treatment Methods

• Medication treatment (first-line choice)
  • Goal: Complete suppression of seizures and maintenance of quality of life (while minimizing side effects)
  • General approach: Start with a single antiseizure medication → adjust the dose according to the response → if the effect is insufficient, use combination therapy or switch to another class
  • Representative older medications: Phenytoin, valproic acid, carbamazepine, phenobarbital, clonazepam, etc.
  • Representative newer medications (examples): Levetiracetam, lamotrigine, topiramate, oxcarbazepine, lacosamide, perampanel, pregabalin, etc.
  • Women of childbearing age: Because valproic acid has a high risk of fetal malformations and developmental disorders, possible alternatives should be considered
• Surgical treatment
  • Among patients with intractable (drug-resistant) epilepsy that cannot be controlled with medication, surgery (such as focal resection) may be considered when the seizure focus is localized and its removal can preserve function
  • Indications: Persistent seizures despite appropriate administration of two or more medications, concordance of the focus on imaging and EEG, etc.
• Other procedures/treatments
  • Deep brain stimulation (DBS), vagus nerve stimulation (VNS), responsive neurostimulation (RNS), dietary therapy (such as the ketogenic diet, considered especially in children), etc.
• Lifestyle management and precautions
  • Take medications exactly as prescribed (discontinuation increases the risk of recurrence)
  • Manage triggers such as alcohol consumption, sleep deprivation, stress, and light stimulation
  • Restrictions on driving and operating machinery (follow local laws and the doctor's recommendations)
  • Learn first aid for seizures (ensure breathing, remove dangerous objects, do not forcibly restrain the person, and contact emergency services if the seizure lasts more than 5 minutes)
• Risk of complications
  • Status epilepticus, trauma (such as falls and burns), increased risk of accidents and death (including SUDEP), mental health problems (depression and anxiety), etc.
• Prognosis summary
  • Approximately 70–80% can achieve seizure control with antiseizure medications. The proportion that cannot be controlled with medication is approximately 20–30% (with considerable individual variation).

Checklist Before an Outpatient Visit (Including Examples of Items to Bring and Questions)

• Items to bring
  • A complete list of currently taken medications (including dosages and dosing times)
  • Medical history: Stroke, head trauma, central nervous system infections, and surgical history
  • Previous test results (photos/CD if possible): Brain MRI, CT, previous EEG, PET, etc.
  • Seizure records (date and time of occurrence, duration, symptoms, recovery course, and triggers) or seizure videos (recorded by a witness)
  • Family history (epilepsy and genetic diseases)
  • Lifestyle habits (sleep, alcohol, substance abuse, etc.)
• Examples of information to provide to the doctor during an outpatient visit (simple sentences)
  • "When was the most recent seizure, and how long did it last?" → Provide the specific date, time, and circumstances
  • "What symptoms did you have before and after the seizure (aura, confusion, etc.)?"
• Information about tests that may be performed during an outpatient visit
  • Physical and neurological examination, blood tests (to check for electrolyte and metabolic abnormalities), brain MRI, standard and video EEG, PET/SPECT if necessary, and genetic testing (when a specific syndrome is suspected)

Examples of General Questions to Ask the Doctor

• "What are the main side effects of this medication, and what should I be aware of with long-term use?"
• "If my seizures are not well controlled, should surgery or another procedure be considered?"
• "What should I be careful about in daily life regarding driving, work, pregnancy, and other matters?"
• "What lifestyle habits (sleep, diet, and stress management) are recommended to reduce seizures?"

Examples of Condition-Specific Questions

• Women (of childbearing age): "I am planning a pregnancy. What effects could the antiseizure medication I am currently taking have on the fetus? Will my medication need to be adjusted?"
• Suspected drug-resistant epilepsy: "I have tried several medications, but my seizures continue. How is my suitability for non-drug treatments such as surgery or VNS/DBS evaluated?"

(Note: The above is a summary combining the information provided in the table with general medical knowledge. Please consult your attending physician regarding specific decisions such as diagnosis, treatment, and medication changes.)