In the past, epilepsy treatment only involved the use of a few types of antiepileptic drugs. These older antiepileptic drugs could control seizures but had quite a few side effects.
Causes of Epilepsy
Epilepsy is a disease found in all genders and ages, affecting about 1% of the Thai population, which is approximately 600,000 cases. The symptoms of epilepsy vary widely, including convulsive seizures as commonly known. Additionally, symptoms such as staring blankly, hand wringing or grasping, hand rubbing back and forth, and twitching of the arms or legs are also considered symptoms of epilepsy. The causes of epilepsy are diverse, such as cerebral artery stenosis or rupture, brain infections, congenital brain abnormalities, and brain tumors, among others.
Epilepsy Treatment
In the past, epilepsy treatment only involved the use of a few types of antiepileptic drugs. These older antiepileptic drugs could control seizures but had quite a few side effects, such as drowsiness, dizziness, swollen gums, hepatitis, and rashes. Treatment of epilepsy with antiepileptic drugs alone could control seizures in only 60-70% of cases. However, there are still many patients—up to one-third of all epilepsy patients—who cannot control seizures with antiepileptic drugs because this treatment addresses only the symptoms, not the root cause of the seizures.
Innovations in Epilepsy Treatment
Currently, new technologies have greatly improved the diagnosis of epilepsy, such as Electroencephalography (EEG). All epilepsy patients should undergo EEG to determine whether the seizures are focal or generalized. The type of seizure is important for treatment because knowing the seizure type allows for selecting the most appropriate antiepileptic drug for each patient, improving seizure control. Additionally, EEG can indicate the cause and the brain area responsible for the seizures.
Moreover, Magnetic Resonance Imaging (MRI) is used to diagnose lesions in patients. This machine provides high clarity and accuracy. MRI is superior to Computed Tomography (CT) scans used in the past, which previously made it difficult to accurately identify the cause of epilepsy. Nowadays, MRI allows for clearer and more precise identification of epilepsy causes.
Regarding treatment, new antiepileptic drugs have been developed that can better control seizures with high safety and fewer side effects, such as reduced drowsiness and dizziness.
Epilepsy Treatment by Surgery
Currently, epilepsy can be treated with highly safe and effective surgical methods. Surgery is used for patients whose seizures cannot be controlled despite maximum use of antiepileptic drugs. These patients often live difficult lives and are at high risk of accidents, such as head injuries or broken limbs. Some experience seizures while driving, posing dangers to themselves and others. Some require large amounts of antiepileptic drugs and cannot work due to constant drowsiness. Surgery is therefore an alternative for patients who do not achieve seizure control with medication alone.
Surgical treatment for epilepsy involves detailed evaluation to locate the seizure origin before surgery. EEG and MRI are performed, and the data are used for diagnosis to pinpoint the seizure focus. This allows precise identification of the seizure origin and surgery limited to the necessary brain area only. Surgical treatment can control seizures in up to 70% of patients who do not respond to medication, with very few side effects and high safety.
It can be seen that nowadays, epilepsy diagnosis uses advanced technologies such as EEG and MRI, leading to more accurate diagnosis. Epilepsy treatment with surgery is highly safe and effectively controls seizures, allowing patients to manage seizures better than with medication alone. This improves patients’ quality of life, enabling them to study, work, and live like others, and reduces accidents that may occur during work or driving.
Dr. Chakrit Sutthisawan
Neurology Specialist
Brain and Nervous System Center, Phyathai 1 Hospital
