Experience in our neurology clinics is that half ofthe epilepsy population in the United States, i.e. more than three millionAmericans (similar percent of the global population afflicted with epilepsy)can control their epilepsy. When the epilepsy is controlled with just theinitial trial of anticonvulsant drugs (ACD) the long term prognosis for thatperson’s epilepsy is very good. We physicians start treatment with a commonlyused ACD that from experience has shown effectiveness at the commonly used dosage.Side-effects such as drowsiness and laboratory tests of liver function, bloodcounts, etc. hopefully won’t be significant and the patient will adapt to thetreatment quickly.

Edward Faught, MD, wrote on the reality and the hopein treatment.1 As our patients are no doubt familiar, thecourse of epilepsy is variable. Experience shows that not achieving goodcontrol averages one-third of the epilepsy population, despite multipledifferent ACD treatments at various dosages. Identifying the presence orabsence of brain lesions can still lead us astray as some patients do welldespite significant abnormalities on scans. Younger age at onset, abnormal EEGsand very frequent seizures can adversely affect the prognosis.

According to the International League AgainstEpilepsy, drug resistant epilepsy is suggested when 2 ACDs appropriate fortheir type of epilepsy, as judged by your experienced neurologist, at tolerateddosages fail, then a third drug probably will also fail to control allseizures, too (10%).2 However, other studies suggesthope. Schiller and Najjar noted that even after 2 to 5 ACDs had failed anotherdrug could possibly produce seizure control. That was found in 16% of thosepatients deemed therapeutic failures.3

Keep in mind that a highly successful treatment thatcan cure epilepsy is brain surgery. In highly selected patients studied to ruleout adverse side effects that would result from surgery, these procedures aresafe. Post surgery life can be normal. Refer to my previous surgery-relatedblogs #155 (Successful surgery with robot assistant:  https://lancefogan.blogspot.com/2017/12/blog-89-surgical-removal-of-seizure.html), # 145 (Epilepsy patient passes driving test after brainsurgery for poorly controlled epilepsy https://lancefogan.blogspot.com/2022/08/blog-145-epilepsy-patient-passes.html), #121 (…Epilepsy surgery issafe.  https://lancefogan.blogspot.com/2020/08/blog-121-if-your-seizures-arent.html).

Inconclusion we should keep in mind that there is always hope in epilepsytherapy.          

1.    FaughtE. Balancing reality with hope in epilepsy therapy. Neurology 2018;91:p989-990.

2.    KwanP, Arzimanoglou A, Berg AT, et.al. Definition of Drug-Resistant Epilepsy Epilepsia2010; 51: 1069-1077.

3.    SchillerY, Najjar Y. Quantifying the response to antiepileptic drugs: effect of pasttreatment history. Neurology 2008; 70: 54-65.

hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view.“DINGS” is his first novel. Aside from acclamation on internet bookstoresites, U.S. Report of Books, and the Hollywood Book Review, DINGS has beenadvertised in recent New York Times Book Reviews, the Los Angeles TimesCalendar section and Publishers Weekly. DINGS teaches epilepsy and is now available ineBook, audiobook, soft and hard cover editions.