Introduction and diganosis
Introduction
As a condition which affects the brain, epilepsy is often associated with cognitive problems. The most commonly reported problems are memory issues alongside other impairments in reasoning, planning, judgement and problem-solving. Language abilities may be affected in some patients.
Epilepsy is common in people with learning disabilities which, for many, can affect communication. Cognitive issues can affect people of all ages and may appear quite early after the diagnosis of epilepsy is made.
Medication used to control seizures and brain surgery can also negatively affect cognition in some patients.
Diagnosis
Epilepsy is usually only diagnosed once the person has had two unprovoked seizures, at which point anti-seizure medication will be started. These medicines used to be called anti-epileptic drugs (AEDs) but this term is not used widely nowadays as the drugs are used to try to control seizures rather than cure the condition itself. Calling them anti-seizure medicines (ASMs) is therefore more accurate.
If this is the first time an ASM has been prescribed for epilepsy, the patient may still be a little stunned by the diagnosis which can have devastating effects on their life, such as possible alterations to employment and having to give up driving.
In all likelihood, patients will need to be on treatment long-term. It is possible for people to come off ASMs but that would not be considered until they have been seizure-free for at least two years. Many patients will be on ASMs for life.
When first diagnosed, most people will be started on one of three ASMs: lamotrigine, levetiracetam or sodium valproate.
ASMs are associated with a similar range of adverse effects. Early onset side-effects include drowsiness and dizziness with seizure aggravation, gastro-intestinal problems and rashes also commonly feature. Hypersensitivity reactions including Stevens-Johnson syndrome (a life-threatening cutaneous reaction) is a rare but serious risk with many ASMs. Late onset side-effects are less heterogeneous, but can include altered blood results, mood disorders and behavioural issues, suicidality and changes in weight. Patients with epilepsy may often put up with quite severe side-effects because the drug has helped with seizure control.
The three most commonly used first-line medicines for seizures
