Ask the Expert: Seizures and Seizure Medication

QUESTION:
I was diagnosed with a brain tumour in late January after having a seizure at work. The surgeon said he got the entire tumour out. For some reason I still have seizures or sometimes just the feeling that I’ll have a seizure, but then the seizure doesn’t come. I’m taking Dilantin, but it makes me feel groggy and affects my thinking. When can I stop this medicine, or should I be on a different medicine? And when will the seizures stop happening?


ANSWER:
The brain is a large bioelectric organ. This electrical activity needs to be tightly regulated by maintaining an appropriate and consistent microenvironment around the electrical cells, called neurons. Epileptic seizures occur when that microenvironment is disrupted, allowing neurons to discharge haphazardly and spontaneously. There are many events that can injure the brain and disrupt the neurons’ environment. Examples include brain tumours, infection, stroke, and scar tissue from surgery or trauma. Many brain tumour patients remain at risk for seizures, even after a successful surgery, because the brain tissue never heals back to its original state, and thus that delicate balance of electrical activity remains disrupted.

If seizures are completely controlled, patients can sometimes eventually wean off their anti-seizure medication. Studies have shown that successful discontinuation of medication varies with the length of time a patient has remained seizure-free. Basically, the longer you have gone without seizures, the better your chances are of remaining seizure-free off the medication. This typically means 3-5 years of treatment. For those who continue to be at high risk for seizures or who are incompletely controlled with their medication, there are many options available for treatment. You are not confined to one drug, and under the guidance of a neurologist, you can usually find a medication regimen that can give you the right combination of seizure control and favourable side effect profile.

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Thank you to Dr. Brian Thiessen for providing his expertise and to BC Cancer Agency for allowing the reproduction of this article.

About the Author: Dr. Brian Thiessen is a Clinical Assistant Professor in the Division of Neurology at Vancouver General Hospital and the Department of Medical Oncology, BC Cancer Agency. He has also been a speaker at Brain Tumour Information Day Conferences and is a 2004 Research Grant Recipient for his project on the molecular genetic analysis of tumour progression in oliogodendrogliomas. The main objective of Dr. Thiessen’s research was to identify the key molecular alterations that underscore tumour progression and treatment-refractory behaviour in oliogodendrogliomas.

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