intractable epilepsy

Specific method for diagnosing epilepsy

Epilepsy is the following three items defined by the International Bureau for Epilepsy.

  • If there are at least two non-induced seizures (meaning that the seizures are not caused by other diseases or trauma) at intervals of 24 hours or more.
  • Even if it is the first seizure, if it can be said that the probability of the second seizure in the next 10 years is 60% or more.
  • When it can be diagnosed as one of epilepsy syndrome, which is grouped by findings such as seizure appearance age, EEG status, imaging test, motor / cognitive function, neurological symptoms, etc.

It can be said that the doctor starts treatment based on this definition.

According to the epilepsy clinical practice guidelines, the specific flow of diagnosis begins with an interview about age, seizure status, medical history, other diseases, regular medicine, family history, and luxury items such as alcohol. This interview will give you a rough exclusion of possibilities other than epilepsy. If you suspect that you have epilepsy, check the seizures by imaging tests such as CT and MRI, and video to determine the seizure type (whether the abnormal discharge that causes the seizure starts from one part or the whole of the brain). And brain wave recording is often done.

After that, we will also check the findings such as motor / cognitive function and neurological symptoms, and judge whether or not it corresponds to epilepsy syndrome. Determining seizure type and epilepsy syndrome classification (if applicable) is very important in deciding future treatment strategies and treatments when starting treatment, and it may take time to make a definitive diagnosis. ..

Treatment of early symptoms of epilepsy

The treatment policy will change depending on the seizure type, epilepsy syndrome, and age, but basically treatment with drugs is performed. It is common for drug treatment to start with a small amount of one type of drug, both domestically and internationally. After that, increase the dose while observing the side effects and effects, and if the seizure still does not subside, start with the next candidate drug in the same small amount and increase the dose. If one drug does not fit, use two or more drugs to control the symptoms.

The drugs that are considered effective in this early stage of treatment often depend on the classification of seizure-type or epilepsy syndrome. Therefore, if the condition is not cured after a certain period of treatment, the diagnosis may be repeated, such as another test. Therefore, it can be said that a definitive diagnosis is very important.

Treatment methods other than therapeutic drugs

Of course, craniotomy is a method other than drug treatment, but here I would like to introduce methods such as vagus nerve stimulation and ketogenic diet. Vagus nerve stimulation is also mentioned in the “Epilepsy Practice Guidelines”, which is used as a reference when treating epilepsy in Japan, and has been covered by insurance since 2010 in Japan. In this method, a device that emits electrical stimulation is placed under the skin of the left chest to stimulate the vagus nerve in the neck to suppress seizures. It is also said to be highly effective in children and generalized seizures, and studies in the United States have reported a seizure reduction rate of about 50%. However, since no large-scale tests have been conducted, it is important to consult with your instructor regarding the use, safety and effectiveness of this method.

The ketogenic diet is a diet that consumes more fat and protein than carbohydrates. It is said that about 50% of seizure suppression can be expected by performing with a certain balance. However, it may cause side effects such as hypoglycemia, nausea, constipation or diarrhea, weight loss, and hypoactivity, so it is basically introduced under the guidance of a doctor during hospitalization. Therefore, it is dangerous to start at home based on the information on the Internet.

About treatment costs and cases requiring surgery

It is said that more than half of the people can control the seizures by drug treatment, but some of them repeat the recurrence even if the seizures have subsided. In such cases, consider whether it is necessary to repeat trial and error with drug treatment or to cure or alleviate the seizure by surgery. However, when performing a craniotomy, it is necessary to be able to identify the location of the brain where the abnormal discharge occurs, and to have no sequelae or tolerable range even if it is excised. As for the cost of surgery, there are many aspects depending on the hospital, and it is a fact that it cannot be said unconditionally. However, according to a survey by a national hospital, if you are hospitalized for epilepsy, you will be hospitalized for about a week on average even if you do not have surgery, and the payment will be about 130,000 yen (if you pay 30% for health insurance). If the cost of treatment is high, consulting with a social worker at the hospital may help you to apply for a high-cost medical treatment system (a system in which the monthly payment limit is determined by your income). I think you should consult the hospital.

Routine precautions for epilepsy

There are several ways to prevent seizures. The first is to try to live a regular life. In epilepsy, a chronic brain-related illness, it is important to have a good rest. That is, lack of sleep increases the likelihood of seizures. Of course, there are individual differences, but it is good to sleep for about 8 to 10 hours for children and about 6 to 8 hours for adults. If you drink alcohol because you can’t sleep, the quality of your sleep may deteriorate and you may fall into a vicious circle of “I can’t get tired even though I’m sleeping”. Alcohol can also make seizures more likely. In this way, sleep is closely related to seizures, so it is important to create an environment where you can sleep soundly. If you still can’t sleep well, be sure to talk to your teacher.

In addition, since seizures are suppressed by keeping the drug concentration in the body constant, it is also an important preventive measure to keep the prescribed dose and remember to take the drug. It is a fact that it is difficult to continue taking the medicine at the timing told by your doctor / pharmacist every day, and if you have any side effects that you are worried about after taking the medicine, you will not want to take more medicine. However, while there are some drugs that have restrictions on the timing of taking the drug in terms of safety and efficacy, there are also drugs that are not important in terms of timing and should be taken at the same time every day (eg, there is no need to take after meals). , Or at night instead of morning, etc.). If you are worried about side effects after taking this medicine or forgetting to take it, it is recommended that you consult your pharmacist / doctor.


Epilepsy practice guidelines

Epilepsy Information Center

Japan Epilepsy Association

National Center for Global Health and Medicine Hospital “Example of estimation of medical expenses when hospitalized”



September 2023