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Safe Life for Epileptics through Research and Results

September 29th, 2017

Taylor Cefalo

AAST
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Introduction

When someone thinks about epilepsy, often, the initial thoughts are associated with a

disease involved with seizures; and unfortunately, they are not wrong. Seizures are the leading

issue of this disease making epilepsy a hard topic to understand. To combat one of the core

issues in this disease, scientists and doctors have undergone studies and research to find solutions

in order to put seizures under control. Researchers have conducted analyses such as medicinal

uses: Citalopram and Levetiracetam, electromagnetic: rTMS and EEG, and dietary: the ketogenic

diet; because of the diversity in anticonvulsant methods, the safety of the patients are in complete

priority. In each of these studies, there are, and imminently will be adverse effects; however, the

severity of each will vary from headaches to mild injuries. Each solution will have its

weaknesses as well as its strengths. What is most important is to promote a safe life for epileptics

through research and results, as well as a general understanding for those who may come across

a person with epilepsy.

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Research

Doctors, scientists, and analyzers alike have undergone hours of extensive research in

finding ways to ensure the safety of epileptics; because of this, they have found methods to

promote wellness for their patients both in the study and outside. Researchers take factors into

consideration such as adverse effects, signs, symptoms, and the study's overall efficacy. Through

research, five sources both credible and scholarly have been analyzed and several components

have been considered.

Citalopram is a drug used on epileptic patients with depression, its purpose was to test the

effectiveness it had on the symptoms as well as the decrease in the number of seizures.

Thirty-nine patients who had mild frequency seizures in the four previous months underwent

treatment with Citalopram in the following four months. In result, all thirty-nine patients

experienced a notable decrease in depressive symptoms; likewise, "An overall improvement in

seizure frequency was observed in the thirty-nine patients who completed the study (Specchio et

al., 2004)." Apart from these outcomes, of the thirty-nine patients who used Citalopram,

twenty-two experienced adverse effects such as headaches, nausea, dizziness, and fatigue.

Nevertheless, Citalopram was concluded to be effective, and a generally safe alternative to

handle depression and seizures in patients with epilepsy considering, the most adverse effects are

commonly found in any patient that were to test general drugs. Like Citalopram, Levetiracetam

is a drug used on patients with epilepsy, specifically children. This multicentric and uncontrolled

study sought out the efficacy and safety of the drug, using 110 children (twenty-one being under

the age of four years) with refractory epilepsy, meaning their type of epilepsy is defined as
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uncontrollable and unpredictable. In a median follow-up of seven months, thirty-nine percent of

seizure frequency had decreased in patients, and nine percent of the 110 became completely

seizure free, even the children under the age four were tolerant of the drug. Despite levetiracetam

being tolerated, fourteen percent of the patients experienced symptoms such as somnolence and

irritability; in another case, a patient faced choreoathetosis, which is the occurrence of

involuntary movements and irregular migrating contractions, following a few doses of

levetiracetam, otherwise, there were no serious adverse effects. To sum up the effectiveness of

this medicine, researchers concluded that, "...levetiracetam may be a valid therapeutic option for

epilepsy in infants and young children (Grosso et al., 2005)" To one's own, both Citalopram and

Levetiracetam are generally two effective ways to handle seizures in a broad age range as well.

Unlike the medications to treat seizures, electronic processes to suppress seizures have

been an upcoming alternative in treating patients with epilepsy. The two examinations are EEG

and rTMS, which researchers studied to obtain further knowledge about specifically, the safety

of both these procedures. The Electroencephalogram is a test used to find problems related to

electrical activity in the brain, in this specific study, Dr. Noe and her colleagues reviewed the

medical records of 428 patients. With the intention of determining the rate of medical

complications in patients who have had diagnostic scalp video-EEG (Noe et al., 2009), Noe took

certain factors into consideration such as an amount of seizures, the type, as well as timing and

presence of adverse outcomes. Of the 149 adult patients, thirty-five experienced seizure clusters

and a total of 752 seizures were recorded. The adverse effects consisted of one episode of status

epilepticus, which are seizures lasting more than five minutes or multiple seizures often within
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periods less than five minutes. Another being three potentially serious electrocardiographic

abnormalities, two cases of postictal psychosis which are delusions, auditory and visual

hallucinations, and four vertebral compression fractures during generalized convulsions (Noe et

al., 2009). There were no deaths, transfers to the ICU, falls, dental injuries, or pulmonary

complications; but, adverse effects that required intervention occurred in twenty-one percent of

the patient's effects. The safety of this procedure is fairly questionable considering the issues

involved with diagnostic scalp video-EEG. Safety should still remain as the necessity as its

standard precautions as well. Repetitive Transcranial Magnetic Stimulation or rTMS is a newer

therapeutic tool used to suppress seizures in epilepsy (Bae et al., 2007). Even though it is a new

"effective" therapeutic solution into handling seizures, the safety is still questionable. Like Noe

and her colleagues, researchers conducted a search to review all studies from January 1990 to

February 2007 in which patients with epilepsy were treated with rTMS (Bae et al., 2007). "We

identified 30 publications that described patients with epilepsy who underwent rTMS, and noted

a total number of relevant subjects, medication usage, incidence of adverse events...(Bae et al.,

2007)". Through Bae's extensive research, the adverse effects were generally mild and affected

about seventeen percent of subjects, headaches being the most common making ten percent. The

most serious effect was a seizure during treatment occurring in four patients making one percent.

"...conclude that the risk of seizures in patients with epilepsy undergoing rTMS is small, and the

risk of other mild adverse events is comparable to that seen when rTMS is used to treat other

diseases. (Bae et al., 2007)" It is concluded that rTMS is nearly safe for patients with epilepsy,

but that rTMS does require further studies to make it a practical form of therapy for the normal

population.
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Being the most unconventional, but also safest and accessible is the ketogenic diet. The

ketogenic diet is a high fat, low carbohydrate diet used to treat epileptic patients. The research

done by Hoon Chul and their colleagues is to evaluate and efficacy and safety of the ketogenic

diet on patients of infancy, childhood, and adolescence with refractory epilepsy. As well as their

initial research, they continued to oversee the patients after discontinuation of the diet. This was

a "retrospective study of epilepsy patients treated with the KD during 1995 through 2003 at the

Korean multicenter. (Hoon Chul et al., 2005)" Researchers measured aspects such as seizure

frequency, electroencephalography, adverse reactions, and antiepileptic drugs. At the beginning

of the study, 199 eligible patients were enrolled and of the patients, half were split into six

months and the other twelve months. 68% and 46% of the patients remained on the diet, 58%

and 41% showed a reduction in seizure frequency, and this included 33% and 25% of whom

became seizure free (Hoon Chul et al., 2005). Statistics have shown that patients who were only

put on the ketogenic diet for six months shown better results compared to the ones at twelve

months. Some challenges that may be confronted with this diet is the cultural boundaries and

nutritional requirement variants, but the ketogenic diet is seen as a safe and effective therapy for

children with refractory epilepsy; it is also seen as the most accessible for any patient willing to

try out a safe method.

Through the analysis of five methods in suppressing seizures, all studies and experiments

result in positive and adverse effects respectively. Citalopram and Levetiracetam proved to both

be effective anticonvulsant solutions, however having their downsides, most issues involved
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headaches, irritability or adversaries that did not require hospitalization. EEG and rTMS are the

least reliable when safety is involved, from the adverse cases found in both studies, there is a

large threshold of danger for patients. Considerably, the most attainable method anticonvulsive

method is for patients to try the ketogenic diet. It had no adverse effects and can be tried without

prescription medication or procedure, the downsides to this method are likely to be dietary

restrictions, cultural boundaries, or nutritional requirement variants. The similar theme between

all these research topics is the acknowledgment and promotion of safety for their patients in each

study, it is vital to uphold this both inside and outside of the lab.
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Conclusion

Epilepsy is still a large issue affecting one in twenty-six people, there is no cure to

end this disease yet; however, researchers are continuing extensive investigation in this

issue. From all the recent advancements in anticonvulsant methods such as medicinal use,

electromagnetic, or diet; researchers are keeping a close eye on the results, efficiency,

and the safety of these. Readers should acknowledge that epilepsy is still a very serious

disease and know the measures people are taking just to find a solution to seizures.
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References

Bae, E. H., Schrader, L. M., Machii, K., Alonso-Alonso, M., Riviello, J. J., Pascual-Leone, A., &

Rotenberg, A. (2007). Safety and tolerability of repetitive transcranial magnetic stimulation in patients with

epilepsy: a review of the literature. Epilepsy & behavior, 10(4), 521-528.

http://www.sciencedirect.com/science/article/pii/S1525505007000807

Chul Kang, H., Joo Kim, Y., Wook Kim, D., & Dong Kim, H. (2005). Efficacy and safety of the ketogenic

diet for intractable childhood epilepsy: Korean multicentric experience. Epilepsia, 46(2), 272-279.

http://onlinelibrary.wiley.com/doi/10.1111/j.0013-9580.2005.48504.x/full

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Efficacy and safety of levetiracetam: an add-on trial in children with refractory epilepsy. Seizure, 14(4), 248-253.

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Noe, K. H., & Drazkowski, J. F. (2009, June). Safety of long-term video-electroencephalographic

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http://www.sciencedirect.com/science/article/pii/S0025619611605806

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