NARCOLEPSY

DESCRIPTION

Narcolepsy is a neurological disorder that causes episodes of unpreventable sleep. These episodes can occur frequently and at inappropriate times, for example while a person is talking, eating or driving. Although sleep episodes can occur at any time, they may be more frequent during periods of inactivity or monotonous, repetitive activity.

Narcolepsy occurs when the part of the brain that regulates sleep and wakefulness does not function properly, causing sudden spells of Rapid-Eye-Movement (REM) sleep – the dreaming state of sleep. These “sleep attacks” last from a few seconds to 30 minutes, regardless of the amount or quality of night time sleep. These attacks result in episodes of sleep at work and social events, while eating, talking, driving, or on other similarly inappropriate occasions.

Symptoms generally begin between the ages of 15 and 30. The four classic symptoms of the disorder (although not all sufferers will have all four) are:

  • Excessive daytime sleepiness.
  • Cataplexy: a striking, sudden episode of muscle weakness triggered by high emotions. Typically, the patient’s knees buckle and may give way upon laughing, elation, fear, surprise or anger. In other typical cataplectic attacks the head may drop or the jaw may become slack. In severe cases, the patient might fall down and become completely paralysed for a few seconds to several minutes. Reflexes are abolished during the attack.
  • Sleep paralysis: the patient suddenly finds himself unable to move for a few minutes, most often upon falling asleep or waking up.
  • Hypnagogic hallucinations: dream-like auditory or visual hallucinations, while dozing or falling asleep.

Disturbed night time sleep, including tossing and turning in bed, leg jerks, nightmares, and frequent awakenings may also occur.

The development, number and severity of symptoms vary widely among individuals with the disorder but excessive sleepiness is usually the first and most prominent symptom of narcolepsy.

It is a frequent disorder, the second leading cause of excessive daytime sleepiness diagnosed by sleep centres after sleep apnea. Studies on the epidemiology of narcolepsy show an incidence of 0.2 to 1.6 per thousand in European countries, Japan and the United States.

In many cases diagnosis is not made until many years after the onset of symptoms. In one recent study, it took on average 14 years from the onset of symptoms to time of diagnosis. This is often due to the fact that patients consult a physician only after many years of excessive sleepiness, assuming that sleepiness is not indicative of a disease. Early diagnosis and treatment, however, are important to the physical and mental well-being of the sufferer, since studies have shown that even treated narcoleptic patients are often markedly psychosocially impaired in the area of work, leisure, interpersonal relations, and are more prone to accidents.

Narcolepsy can be diagnosed on the basis of a history of typical episodes and the results of an overnight sleep study with a multiple sleep latency test. The sleep study checks for other explanations that could account for daytime sleepiness, such as sleep deprivation, sleep apnoea and depression. The test is done in a sleep laboratory, where brain waves, eye movements, muscle activity, heartbeat, blood oxygen levels and respiration are monitored electronically with a device called a polysomnograph. The multiple sleep latency test is performed after an adequate night’s sleep has been demonstrated clearly. Usually, it is done after a sleep study.

The test consists of four 20-minute opportunities to nap, which are offered every two hours throughout the day. Patients with narcolepsy fall asleep in approximately five minutes or less, and transition in REM sleep during at least two of the four naps. In contrast, normal subjects take an average of 12 to 14 minutes to fall asleep, and show no REM sleep.

TREATMENT

There is at this time no cure for narcolepsy and there is no way to prevent narcolepsy but the symptoms can be controlled with behavioural and medical therapy. Excessive daytime sleepiness may be treated with stimulant drugs or with the drug modafinil. Cataplexy and other REM-sleep symptoms may be treated with antidepressant medications.

At best, medications will reduce the symptoms, but will not alleviate them entirely. Also, many currently available medications have side effects.

Lifestyle adjustments such as regulating sleep schedules, scheduled daytime naps and avoiding “over-stimulating” situations may also help to reduce the intrusion of symptoms into daytime activities.

PROGNOSIS

People with narcolepsy have a significantly increased risk of death or serious injury resulting from motor-vehicle or job-related accidents, and they must take care to avoid situations where such accidents might occur.

Although it is a life-long condition, most individuals with the narcolepsy enjoy a near-normal lifestyle with adequate medication and support from teachers, employers, and families. If not properly diagnosed and treated, narcolepsy may have a devastating impact on the life of the affected individual, causing social, educational, psychological, and financial difficulties

Alzheimer’s

Alzheimer’s disease is the most common form of dementia (around 60% of diagnoses in the UK), although it is comparatively rare for under-65s.

What causes Alzheimer’s disease?

The exact cause is unknown but we do know that ‘plaques’ and ‘tangles’ form in the brain due to two proteins called amyloid (plaques) and tau (tangles).

  • Amyloid is a naturally occurring protein which for a reason that is not yet understood begins to malfunction, creating beta amyloid which is toxic to the brain cells. Plaques form consisting of dead cells and amyloid protein.
  • Tau protein naturally occurs in the brain and helps brain cells communicate with each other but for a reason that is not yet understood it can become abnormal and “clump together” leading to death of the brain cells affected.

People diagnosed with Alzheimer’s may additionally have a reduction of a chemical in the brain (called acetylcholine). This functions as a chemical messenger to take information to and from brain cells (neurons), so a reduction in this chemical leads to information not being transmitted effectively.

How does Alzheimer’s develop?

Research suggests that changes in the brain can occur up to ten years before a person starts to show symptoms of Alzheimer’s disease. The symptoms are usually mild at the beginning and gradually worsen over time. These may include:

  • difficulty remembering recent events while having a good memory for past events
  • poor concentration
  • difficulty recognising people or objects
  • poor organisation skills
  • confusion
  • disorientation
  • slow, muddled or repetitive speech
  • withdrawal from family and friends
  • problems with decision making, problem solving, planning and sequencing tasks

Managing the effects of Alzheimer’s disease

Medication is available which may help slow progression but it does not prevent or cure Alzheimer’s disease.

  • People with Alzheimer’s may be prescribed a type of medication called cholinesterase inhibitors. There are three options: Donepezil, Rivastigmine or Galantamine
  • These medications may improve concentration, which helps with memory, thinking and language. These effects can last for approximately 6-12 months, although there is now some evidence showing they can benefit a person for much longer. They support the communication between the nerve cells in the brain by preventing the breakdown of acetylcholine
  • Memantine can also be prescribed in the moderate to severe stage of Alzheimer’s disease alongside one of the above medications. This medication blocks the effects of excess glutamate in the brain. Memantine can help with memory, reasoning, language and attention

Schizophrenia

Overview

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.

Onset and Symptoms

Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). A diagnosis of schizophrenia often follows the first episode of psychosis, when individuals first display symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence. Schizophrenia can occur in younger children, but it is rare for it to occur before late adolescence.

The symptoms of schizophrenia generally fall into the following three categories:

Psychotic symptoms include altered perceptions (e.g., changes in vision, hearing, smell, touch, and taste), abnormal thinking, and odd behaviors. People with psychotic symptoms may lose a shared sense of reality and experience themselves and the world in a distorted way. Specifically, individuals typically experience:

  • Hallucinations, such as hearing voices or seeing things that aren’t there
  • Delusions, which are firmly held beliefs not supported by objective facts (e.g., paranoia – irrational fears that others are “out to get you” or believing that the television, radio, or internet are broadcasting special messages that require some response)
  • Thought disorder, which includes unusual thinking or disorganized speech

Negative symptoms include loss of motivation, disinterest or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally. Specifically, individuals typically have:

  • Reduced motivation and difficulty planning, beginning, and sustaining activities
  • Diminished feelings of pleasure in everyday life
  • “Flat affect,” or reduced expression of emotions via facial expression or voice tone
  • Reduced speaking

Cognitive symptoms include problems in attention, concentration, and memory. For some individuals, the cognitive symptoms of schizophrenia are subtle, but for others, they are more prominent and interfere with activities like following conversations, learning new things, or remembering appointments. Specifically, individuals typically experience:

  • Difficulty processing information to make decisions
  • Problems using information immediately after learning it
  • Trouble focusing or paying attention

Risk Factors

Several factors contribute to the risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, it is important to know that just because someone in a family has schizophrenia, it does not mean that other members of the family will have it as well. Genetic studies strongly suggest that many different genes increase the risk of developing schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.

Environment: Scientists think that interactions between genetic risk and aspects of an individual’s environment may play a role in the development of schizophrenia. Environmental factors that may be involved include living in poverty, stressful surroundings, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Scientists think that differences in brain structure, function, and interactions among chemical messengers (called neurotransmitters) may contribute to the development of schizophrenia. For example, differences in the volumes of specific components of the brain, in the way regions of the brain are connected and work together, and in neurotransmitters, such as dopamine, are found in people with schizophrenia. Differences in brain connections and brain circuits seen in people with schizophrenia may begin developing before birth. Changes to the brain that occur during puberty may trigger psychotic episodes in people who are vulnerable due to genetics, environmental exposures, or the types of brain differences mentioned above.

Treatments and Therapies

The causes of schizophrenia are complex and are not fully understood, so current treatments focus on managing symptoms and solving problems related to day to day functioning. Treatments include:

Antipsychotic Medications

Antipsychotic medications can help reduce the intensity and frequency of psychotic symptoms. They are usually taken daily in pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month, which some individuals find to be more convenient than daily oral doses. Patients whose symptoms do not improve with standard antipsychotic medication typically receive clozapine. People treated with clozapine must undergo routine blood testing to detect a potentially dangerous side effect that occurs in 1-2% of patients.

Many people taking antipsychotic medications have side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects subside over time, but others may persist, which may cause some people to consider stopping their antipsychotic medication. Suddenly stopping medication can be dangerous and it can make schizophrenia symptoms worse. People should not stop taking antipsychotic medication without talking to a health care provider first.

Shared decision making between doctors and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose. You can find the latest information on warnings, patient medication guides, or newly approved medications on the U.S. Food and Drug Administration (FDA) website.

Psychosocial Treatments

Cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions may help address the negative and cognitive symptoms of schizophrenia. A combination of these therapies and antipsychotic medication is common. Psychosocial treatments can be helpful for teaching and improving coping skills to address the everyday challenges of schizophrenia. They can help people pursue their life goals, such as attending school, working, or forming relationships. Individuals who participate in regular psychosocial treatment are less likely to relapse or be hospitalized. For more information on psychosocial treatments, see the Psychotherapies webpage on the NIMH website.

Family Education and Support

Educational programs for family members, significant others, and friends offer instruction about schizophrenia symptoms and treatments, and strategies for assisting the person with the illness. Increasing key supporters’ understanding of psychotic symptoms, treatment options, and the course of recovery can lessen their distress, bolster coping and empowerment, and strengthen their capacity to offer effective assistance. Family-based services may be provided on an individual basis or through multi-family workshops and support groups. For more information about family-based services in your area, you can visit the family education and support groups page on the National Alliance on Mental Illness website.

Coordinated Specialty Care

Coordinated specialty care (CSC) is a general term used to describe recovery-oriented treatment programs for people with first episode psychosis, an early stage of schizophrenia. A team of health professionals and specialists deliver CSC, which includes psychotherapy, medication management, case management, employment and education support, and family education and support. The person with early psychosis and the team work together to make treatment decisions, involving family members as much as possible. Compared to typical care for early psychosis, CSC is more effective at reducing symptoms, improving quality of life, and increasing involvement in work or school. Check here for more information about CSC programs.

Assertive Community Treatment

Assertive Community Treatment (ACT) is designed especially for individuals with schizophrenia who are at risk for repeated hospitalizations or homelessness. The key elements of ACT include a multidisciplinary team, including a medication prescriber, a shared caseload among team members, direct service provision by team members, a high frequency of patient contact, low patient to staff ratios, and outreach to patients in the community. ACT reduces hospitalizations and homelessness among individuals with schizophrenia. Check here for more information about ACT programs.

How can I help someone I know with schizophrenia?

Caring for and supporting a loved one with schizophrenia can be very challenging. It can be difficult to know how to respond to someone who is experiencing psychosis.

Here are some things you can do to help your loved one:

  • Help them get treatment and encourage them to stay in treatment
  • Remember that their beliefs or hallucinations seem very real to them
  • Tell them that you acknowledge that everyone has the right to see things their way
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior
  • Check to see if there are any support groups in your area

Some symptoms require immediate emergency care. If your loved one is thinking about harming themselves or others or attempting suicide, seek help right away:

Finding Help

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator for finding mental health treatment facilities and programs. SAMHSA’s Early Serious Mental Illness Treatment Locator provides information about treatment facilities that offer coordinated specialty care. For additional resources, visit the NIMH Help for Mental Illnesses page.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit directly from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge to help others in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your doctor about clinical trials, their benefits and risks, and whether one is right for you.

Caring for someone with Bipolar

Caring for someone with bipolar disorder can be very hard, whether you’re a partner, parent, child, or friend of someone who has this condition. It’s stressful for everyone it touches.

It’s tough to strike a balance. You want to be supportive and empathetic, because you know the person with bipolar disorder isn’t to blame for their illness. But their behavior may affect you, and you have to take care of yourself and your needs, not just theirs.

Although there’s no easy solution, these tips may help.

Learn. Read information from reputable web sites, books, and articles that explain the condition. The more you know, the better.

Listen. Pay attention to what your loved one has to say. Don’t assume that you know what he or she is going through. Don’t dismiss all of their emotions and feelings as signs of their illness. Someone with bipolar disorder may still have valid points.

Encourage them to stick with treatment. Your love one needs to take their bipolar medication and get regular checkups or counseling.

Notice their symptoms. They may not be able to see it as clearly as you do when their bipolar symptoms are active. Or they may deny it. When you see the warning signs of mania or depression, you can try to make sure they get help ASAP.

Do things together. People who are depressed often pull away from others. So encourage your friend or loved one to get out and do things he or she enjoys. Ask him to join you for a walk or a dinner out. If he says no, let it go. Ask again a few days later.

Make a plan. Because bipolar disorder can often be an unpredictable illness, you should plan for bad times. Be clear. Agree with your loved one about what to do if their symptoms get worse. Have a plan for emergencies. If you both know what to do and what to expect of each other, you’ll feel more confident about the future.

Stick to a schedule. If you live with someone who has bipolar disorder, encourage them to stick to a schedule for sleep and other daily activities. Some research shows that it’s helpful to have a regular routine. The person will still need medicine and counseling, but look for everyday things, like exercise and a healthy diet, that supports their overall health.

Express your own concerns. Since your loved one’s behavior can have a huge effect on you, it’s OK to discuss. Don’t blame the other person or list all of his mistakes. Instead, focus on how his actions make you feel and how they affect you. Since this can be really hard to do, you might find it easiest to talk about it together with a therapist.

Take care of yourself. As intense as your loved one’s needs may be, you count, too. It’s important for you to stay healthy emotionally and physically.

Do things that you enjoy. Stay involved with other people you’re close to — social support and those relationships mean a lot. Think about seeing a therapist on your own or joining a support group for other people who are close to someone who has bipolar disorder.

Medication for epilepsy

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Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy do not have seizures. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures.

Medicines used to treat epilepsy

These include:
Carbamazepineclobazamclonazepameslicarbazepineethosuximidegabapentinlacosamidelamotriginelevetiracetamoxcarbazepineperampanelphenobarbitalphenytoinpregabalinprimidonerufinamidesodium valproatetiagabinetopiramatevigabatrin and zonisamide. They all come with different brand names.

Sodium valproate is commonly used as a treatment for epilepsy. In April 2018, the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK recommended that valproate must no longer be used for any women or girl who could become pregnant unless a Pregnancy Prevention Programme is in place. The Pregnancy Prevention Programme is a system of ensuring all female patients taking valproate medicines:

  • Have been told and understand the risks of use in pregnancy and have signed a Risk Acknowledgement Form.
  • Are on highly effective contraception if necessary.
  • See their specialist at least every year.

How effective is medication used for epilepsy?

The success in controlling seizures by medication varies depending on the type of epilepsy. For example, if no underlying cause can be found for your seizures (idiopathic epilepsy), you have a very good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control.

The overall outlook is better than many people realise. The following figures are based on studies of people with epilepsy, which looked back over a five-year period. These figures are based on grouping together people with all types of epilepsy, which gives an overall picture:

  • About 5 in 10 people with epilepsy will have no seizures at all over a five-year period. Many of these people will be taking medication to control seizures. Some will have stopped treatment having had two or more years without a seizure whilst taking medication.
  • About 3 in 10 people with epilepsy will have some seizures in this five-year period but far fewer than if they had not taken medication.
  • So, in total, with medication about 8 in 10 people with epilepsy are well controlled with either no, or few, seizures.
  • The remaining 2 in 10 people experience seizures, despite medication.

Which medicine is the most suitable?

Deciding on which medicine to prescribe depends on such things as:

  • Your type of epilepsy.
  • Your age.
  • Other medicines that you may take for other conditions.
  • Possible side-effects.
  • Whether you are pregnant or planning a pregnancy.

There are popular first-choice medicines for each type of epilepsy. However, if one medicine does not suit, another may be better.

A low dose is usually started. The aim is to control seizures at the lowest dose possible. If you have further seizures, the dose is usually increased. There is a maximum dose allowed for each medicine. In about 7 in 10 cases, one medicine can control all, or most, seizures. Medicines may come as tablets, soluble tablets, capsules or liquids to suit all ages.

What if seizures still occur?

In about 3 in 10 cases, seizures are not controlled despite taking one medicine. This may be because the dosage or timing of the medication needs re-assessing. A common reason why seizures continue to occur is because medication is not taken correctly. If in doubt, your doctor or pharmacist can offer advice.

If you have taken a medicine correctly up to its maximum allowed dose but it has not worked well to control your seizures, you may be advised to try a different medicine. If that does not work alone, taking two medicines together may be advised. However, in about 2 in 10 cases, seizures are not well controlled even with two medicines.

When is medication started?

The decision when to start medication may be difficult. A first seizure may not mean that you have ongoing epilepsy. A second seizure may never happen, or occur years after the first. For many people, it is difficult to predict if seizures will recur.

Another factor to consider is how severe seizures are. If the first seizure was severe, you may opt to start medication immediately. In contrast, some people have seizures with relatively mild symptoms. Even if the seizures occur quite often, they might not cause much problem and some people in this situation opt not to take any medication.

The decision to start medication should be made by weighing up all the pros and cons of starting, or not starting, treatment. A popular option is to wait and see after a first seizure. If you have a second seizure within a few months, more are likely. Medication is commonly started after a second seizure that occurs within 12 months of the first. However, there are no definite rules and the decision to start medication should be made after a full discussion with your doctor.

What about side-effects?

All medicines have possible side-effects that affect some people. All known possible side-effects are listed in the leaflet which comes in the medicine packet. If you read this it may appear alarming. However, in practice, most people have few or no side-effects, or just minor ones. Many side-effects listed are rare. Each medicine has its own set of possible side-effects. Therefore, if you are troubled with a side-effect, a change of medication may resolve the problem.

When you start a medicine, ask your doctor about any problems which may arise for your particular medicine. Two groups of problems may be mentioned:

  • Side-effects which are relatively common but are not usually serious. For example, sleepiness is a common side-effect of some medicines. This tends to be worse when first started. This problem often eases or goes once the body gets used to the medicine. Other minor side-effects may settle down after a few weeks of treatment. If you become unsteady, it may indicate the dose is too high.
  • Side-effects which are serious but rare. Your doctor may advise what to look out for. For example, it is important to report any rashes or bruising whilst taking some types of medicine.

Note: you should not stop taking a medicine suddenly. If you notice a side-effect, you should ask your doctor for advice.

Taking your medication correctly

It is important to take your medicine as prescribed. Try to get into a daily routine. Forgetting an occasional dose is not a problem for some people; however, for others this would lead to breakthrough seizures. One of the reasons why seizures recur is due to medication not having been taken properly. A pharmacist can be a good source of advice if you have any queries about medication.

Prescription medicines are free if you have epilepsy

You will need an exemption certificate. Ask your pharmacist for details.

Some medicines taken for other conditions may interfere with medication for epilepsy. If you are prescribed or buy another medicine, always remind your doctor or pharmacist that you take medication for epilepsy. Even preparations such as indigestion medicines may interact with your epilepsy medication, which may increase your chance of having a seizure.

Some epilepsy treatments interfere with the contraceptive pill. You may need a higher-dose pill or an alternative method of contraception. For reliable contraception, it is best to seek advice from a doctor or nurse. They will be able to tell you if your epilepsy treatment affects any methods of contraception.

For women with epilepsy, the risk of complications during pregnancy and labour is slightly higher than for women without epilepsy. The small increase in risk is due to the small risk of harm coming to a baby if you have a serious seizure whilst pregnant. There is also a small risk of harm to an unborn baby from anti-epilepsy medicines.

Before becoming pregnant it is important to seek advice from your doctor. Any potential risks can be discussed. For example, to go over your current medication and to see if it should be changed to minimise the risk of harm to a developing baby. One important point is that you should take extra folic acid (folate) before becoming pregnant and continue it until you are 12 weeks pregnant.

If you have an unplanned pregnancy, you should not stop epilepsy medication, which may risk a seizure occurring. Continue your medication and see a doctor as soon as possible. See the separate leaflet called Epilepsy and Planning Pregnancy for more details.

You may wish to consider stopping medication if you have not had any seizures for two or more years. It is important to discuss this with a doctor. The chance of seizures recurring is higher for some types of epilepsy than others. Overall, if you have not had any seizures for 2-3 years and you then stop medication:

  • About 6 in 10 people will remain free of seizures two years after stopping medication. If seizures do not return within two years after stopping medication, the long-term outlook is good. However, there is still a small chance of a recurrence in the future.
  • About 4 in 10 people will have a recurrence within two years.

There are many different types of epilepsy, some of which are age-dependent but some that will need medication for life. Your epilepsy specialist should be able to offer you more advice about the long-term outlook for your particular type of epilepsy.

Your life circumstances may influence the decision about stopping medication. For example, if you have recently regained your driving licence, the risk of losing it again for a year if a seizure occurs may affect your decision. However, if you are a teenager who has been free of seizures for some years, you may be happy to take the risk.

If a decision is made to stop medication, it is best done gradually, reducing the dose over a period of several weeks or months. It is important to follow the advice given by your doctor.

  • Surgery to remove a small part of the brain, which is the underlying cause of the epilepsy. Surgery is only possible for a minority of people with epilepsy and it may be considered when medication fails to prevent seizures, especially focal seizures (used to be called partial seizures). Only a small number of people with epilepsy are suitable for surgery and, even for those that are, there are no guarantees of success. Also, there are risks from operations. However, surgical techniques continue to improve and surgery may become an option for more and more people in the future.
  • Vagal nerve stimulation is a treatment for epilepsy where a small generator is implanted under the skin below the left collarbone. The vagus nerve is stimulated to reduce the frequency and intensity of seizures. This can be suitable for some people with seizures that are difficult to control with medication.
  • The ketogenic diet is a diet very high in fat, low in protein and almost carbohydrate-free. This can be effective in the treatment of difficult-to-control seizures in some children.
  • Complementary therapies such as aromatherapy may help with relaxation and relieve stress but have no proven effect on preventing seizures.
  • Counselling. Some people with epilepsy become anxious or depressed about their condition. A doctor may be able to arrange counselling with the aim of overcoming such feelings. Genetic counselling may be appropriate if the type of epilepsy is thought to have an hereditary pattern.

Some people with epilepsy are prescribed a medicine that a relative or friend can administer in emergencies to stop a prolonged seizure. In most people with epilepsy, seizures do not last more than a few minutes. However, in some cases a seizure lasts longer and a medicine can be used to stop it. A doctor or nurse should give instruction on how and when to administer the medicine.

The most commonly used medicine for this is diazepam. This can be squirted from a tube into the person’s anus (rectal diazepam). This is absorbed quickly into the bloodstream from the rectum and so works quickly. More recently, a medicine called midazolam has been used which is easier to administer. It is squirted into the sides of the mouth where it is absorbed directly into the bloodstream.

There is often no apparent reason why a seizure occurs at one time and not another. However, some people with epilepsy find that certain triggers make a seizure more likely. These are not the cause of epilepsy but may trigger a seizure on some occasions.

Possible triggers may include:

  • Stress or anxiety.
  • Heavy drinking.
  • Street drugs.
  • Some medicines such as antidepressants, antipsychotic medication.
  • Lack of sleep, or tiredness.
  • Irregular meals which cause a low blood sugar level.
  • Flickering lights such as from strobe lighting.
  • Periods (menstruation).
  • Illnesses which cause a high temperature (fever), such as flu or other infections.

If you suspect a trigger it may be worth keeping a diary to see if there is any pattern to the seizures. Some are unavoidable but treatment may be able to be tailored to some triggers. For example:

  • Keeping to regular mealtimes and bedtimes may be helpful for some people.
  • Learning to relax may help. Your doctor may be able to advise about relaxation techniques.
  • A small number of people with epilepsy have photosensitive seizures. This means that seizures may be triggered by flickering lights from the TV, video games, disco lights, etc. Avoiding these may be an important part of treatment for some people. (Photosensitive epilepsy can be confirmed by hospital tests. Most people with epilepsy do not have photosensitive seizures and do not have to avoid TVs, videos, discos, etc.)