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Doctors offer a variety of solutions for epilepsy patients

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SALT LAKE CITY — A variety of medications are available to help epilepsy patients manage seizures, however, some cannot tolerate the side effects and others are not responsive to medications at all, requiring surgical treatment.

The key, said Dr. Jeffrey Bigelow, a neurologist and epileptologist at the Intermountain Medical Center's Epilepsy Clinic, is to see a doctor regularly and get on the right dose of a medication.

"A lot of patients take seizure medications and have absolutely no side effects," he said, adding that older medications tend to have more side effects than newer ones. Bigelow said roughly 25 percent of patients with epilepsy struggle to manage their seizures, with or without medication.

Bigelow and Jody Anderson, a nurse practitioner at the clinic, were on hand to answer dozens of questions from readers during Saturday's Deseret News/Intermountain Healthcare Health Hotline on epilepsy.

Patients who are not responsive to medication can resort to surgical treatment methods, including insertion of a vagal nerve stimulator, or brain surgery to remove the affected portion of the brain that is causing seizures.

While death is not a common result of seizures, Bigelow said patients should be aware of Sudden Unexpected Death in Epilepsy, which affects less than 1 percent of patients. Those at highest risk are individuals suffering from uncontrolled convulsive seizures, typically someone not taking any medications for seizure control.

It remains unknown what causes SUDEP, but Bigelow said a common medical belief is that if abnormal electrical activity exists in the brain, it may also be present in the heart, causing it to stop suddenly, resulting in death. With so few cases, he said the condition is hard to research.

"Patients should be aware of it," he said. "They should not live in fear of it, but hopefully it motivates them to get the treatment they need."

The occurrence of seizures can also often lead a person to have depression or added anxiety about their condition. Epilepsy can take away a person's ability to drive and work, as well as affect their memory and lifestyle.

Anderson said epileptic patients can and should be treated for depression with a variety of medications, as well as counselling. She said treating the epilepsy can also help alleviate depression.

Another concern, and a common question at the clinic, Anderson said, is the risks associated with pregnancy among female epileptic patients.

Seizure medications often present a small chance for birth defects, but Bigelow said it is much more important to avoid seizures during pregancy. Some medications offer a higher risk than others, so it is important to discuss the risks with a doctor about a year before deciding to conceive, he said. Regular blood work during pregnancy is also helpful to maintain the correct dose of any medication.

Patients taking seizure medication are also counseled to take sufficient amounts of folic acid and a multivitamin, as the drugs can affect the levels of folate and other minerals. Bigelow said some seizure medications taken long-term can lead to a loss of bone density.

With one in 10 people expected to experience a seizure at some point in their life, and causes linked not only to genetics, but to stress, heat exhaustion, dehydration, brain or traumatic injury and many other unknown causes, it is important to receive the proper medical care, including doctors specialized in seizure treatment.

The Intermountain clinic houses dedicated doctors, including Bigelow and Dr. Tawnya Constantino, EEG services to better map brain activity, advanced MRI technology, neuropsychologists, technicians and neurosurgeons. Its unique hospital setting allows for long-term monitoring and recording of brain activity to best diagnose epilepsy and other neurological problems.

Local support groups, including the Epilepsy Alliance of Utah (www.utahepilepsy.org) and the Epilepsy Association of Utah (www.epilepsyut.org) offer a variety of resources to epilepsy patients and their families.

The health hotline is offered to readers through a partnership between Intermountain Healthcare and the Deseret News. It covers a different health topic the second Saturday of each month.

E-mail: wleonard@desnews.com Twitter: wendyleonards