Running Head: ORIGINAL WORK

Original Work
Sriharika Gottipolu
Independence High School
February 9, 2016

ORIGINAL WORK

Abstract
This research talks about Epilepsy, a chronic condition characterized by recurrent and
unprovoked seizures. It also talks about the different types of seizures, generalized seizures,
and partial seizures. It mentions the three different types of treatments, drug therapy, surgery,
and ketogenic diet. Finally, it talks about a rubric created for the evaluation of the different
types of drug treatments. The rubric was used to analyze the treatments, and it was determined
that drug therapy was the most effective treatment used in order to treat the effects of
Epilepsy.

ORIGINAL WORK

Epilepsy
Epilepsy is one of the most common neurological diseases worldwide, with about 65
million people affected by it. It is a chronic disorder characterized by recurrent and unprovoked
seizures. The seizures occur as a result of a sudden surge of electrical activity in the brain.
Normally, brain cells either excite or inhibit other brain cells from sending messages. There is a
balance among these brain cells, with half acting as excitatory, and other half acting as
inhibitory. When a seizure occurs, there may be too much or too little activity, which causes
chemical imbalances. These chemical imbalances are what lead to an increase in electrical
activity, which then can cause seizures. The predominant cause of Epilepsy is unknown,
although it has been linked to an brain injuries and heredity.

Generalized Seizures
There are various types of seizures that an individual with Epilepsy may be affected by.
The two major categories are generalized seizures, which involve electrical impulses across the
entire brain, and partial seizures, which involve electrical impulses in only a portion of the brain.
Within generalized seizures, there are six subcategories. The first is a grand mal seizure. The
individual will often become unconscious, and have convulsions and muscle rigidity when
experiencing this type of seizure. Injuries and accidents are most common during grand mal
seizures. The second type of seizure is an absence seizure. This type of seizure is characterized
by a brief loss in consciousness, in which the patient
interrupts an activity and stares blankly for
a short period of time. The patient is usually unaware that he/she is having a seizure. The third
type of seizure is a myoclonic seizure. This type of seizure consists of occasional jerks. The
patient usually feels as if these je
rks are electrical shocks. The fourth is a clonic seizure. These

ORIGINAL WORK

seizures involve repetitive jerks of the body. The fifth type is a tonic seizure. These seizures are
characterized by the stiffening of muscles. The last type of generalized seizures is an atonic
seizure. This seizure results in a loss of muscle tone, which causes the individual to collapse.

Partial Seizures
The other category, partial seizures, contains three subcategories. The first is simple
partial seizures. Simple partial seizures can further be broken down into three categories:
simple motor, which results in jerking, muscle rigidity, and spasms, simple sensory, which results
in unusual sensations involving the human sensory system, and simple psychological, which
involves emotional and memory disturbances. The second type of partial seizures is a complex
seizure. This type of seizure is essentially the impairment of awareness. The patient may have
involuntary, but automated movements, including lip smacking, chewing, fidgeting. The last type
of partial seizure is a partial seizure with secondary generalization. The patient will have a focal
seizure, which later transforms into a grand mal seizure.

Overview of Treatments
In order to treat the various types of seizures, there are three predominant treatments
available. The first is drug therapy, which is the most commonly used treatment. It involves the
use of an array of drugs, as well as combination drug treatments. The second type of treatment
is surgery. This type of treatment is typically used to treat partial seizures, those that affect only
portions of the brain. The final type of treatment, the ketogenic diet, is the least commonly used
treatment. It is typically used in children and involves a change in diet, involving high fat and low
carbohydrate nutrition. All of these treatments have many advantages and disadvantages, and
have shown different results among various demographics.

ORIGINAL WORK

Drug Therapy
Drug therapy is a relatively effective treatment used by epileptic patients. The most
common drug treatments include Valium (Diazepam), Lamictal (Lamotrigine), Keppra
(Levetiracetam), Neurontin (Gabapentin), and Depakote (Valproic Acid). Based on research
studies, Lamictal has shown best results for patients with partial seizures, while Depakote has
showed the best results for generalized seizures. However, the choice of drug treatment varies
based on the patients tolerance of side effects, other illnesses he or she might have, and the
medication's delivery method. As with any other medication, anticonvulsants have some side
effects that increase as the dosage increases. Typically the body will become accustomed to the
side effects as treatment progresses. The main rule of thumb when administering these drugs is
to start patients at a low dose, and increase the strength as the patient becomes accustomed to
it. Some common side effects of anticonvulsants in general include
blurry or double vision,
fatigue, sleepiness, unsteadiness, and stomach upset. Sometimes patients have idiosyncratic
side effects, which are completely unrelated to the strength of the medication. These side
effects include skin rashes, liver problems, and low blood cell count. How long the patient must
be on medication can vary. Some individuals can stop medication after a few years, while others
must take it lifelong. Patients will typically stop medication if they have been seizure free for a
time period that the physician deems is appropriate based on the type of Epilepsy he/she has.
What is clear, however, is that medication should be weaned off gradually, so that it will not
trigger any seizures. Furthermore, it has a cost range of $110-$460, depending on the
medication.

ORIGINAL WORK

Surgery
The next type of treatment option is surgery. Surgery is usually performed when the
medicati
on does not have the desired effects. It is not performed on individuals who have
cancer, heart disease, or other serious medical problems. Usually, only about 30% of the
Epileptic population does not respond to drug treatment. Surgery is done on the brain to
improve the quality of life. There are three main types of surgery.The first removes the area of
the brain producing seizures. The second interrupts the nerve pathways through which seizure
impulses spread within the brain. The third type implants a device in the brain that is used to
treat epilepsy. Surgery is only considered an option when an area of the brain where the
seizures start can be identified. Additionally, the area must not involve critical functions such as
language, sensation, and movement. Extensive evaluation and testing are necessary to
determine if surgery is appropriate. The success rate of surgery varies from between 50% and
80%. Some people become seizure free, others have significantly reduced frequency of
seizures. For some people, it is not successful the first time around, and a second operation must
be performed. Doctors recommend the continuing the use of seizure medication for up to a year
after surgery to ensure that seizure occurrences are rare. Additionally, there are many risks
associated with surgery. It can lead to infections, bleeding, and allergic reactions due to the
anesthesia. It can also cause neurological impacts, including the loss of speech, vision, memory,
and movement. Surgery is one of the more expensive options, and can cost an average of
$12,000.

Ketogenic Diet

ORIGINAL WORK

The final type of treatment is the ketogenic diet. It is a high-fat, low-carbohydrate diet
that helps to control seizures in some epileptic individuals. It is prescribed by a physician and
carefully monitored by a dietitian. It requires careful measurements of calories, fluids, and
proteins. The body uses fats instead of carbohydrates as its primary source of energy. Studies
have shown that higher ketone levels, which occurs as a result of the bodys use of fats as the
primary energy source, can lower occurrence of seizures. This diet is typically followed by
children who have not had success with seizure medications. It is very difficult to follow for
adults, so doctors try to recommend other options. It does not provide immediate seizure relief,
but does have successful results for the long term. If seizure occurrence has dramatically
reduced over two years, the patient can gradually come off of the diet. The diet itself consists of
a 4:1 ratio of grams of fat versus protein and carbohydrates. Typically, the dietitian will
recommend 75 to 100 calories for every kilogram of body weight and 1-2 grams of protein for
every kilogram of body weight. Types of foods high in fat that the patient can consume include
butter, heavy whipping cream, mayonnaise, and oils. Additionally, the patient will have to take
vitamin supplements in order to have balanced nutrition.The diet will first begin in a hospital
setting so that the doctors can monitor the patient in the beginning stages for any negative signs
of seizures. Then, the patient will continue this diet at home. The patient will have to continue
their seizure medications while on this diet. It is more difficult to follow than either of the other
treatment plans simply because the patient will have to stick to the diet 100%, which can be
especially hard for children, and adults alike. It does have some negative side effects including
fatigue, kidney stones, high cholesterol levels in the blood, dehydration, constipation, slowed
growth or weight gain, and bone fractures. However, it has had a 50% success rate in the
patients that have tried it.

ORIGINAL WORK

Rubric
In order to evaluate which treatment would work for the majority of the Epileptic
population, a rubric was developed. This rubric has four separate categories. The first is long
term effectiveness. This determines how effective this treatment has been in stopping the
recurrence of seizures. The second category is cost. This will determine how much the patient
will have to pay for each type of treatment. The third category is side effects. This determines
the negative impacts these treatments can have on each individual. The final category is the
duration of treatment. This determines how long the individual must be on treatment in order to
see the effects of the treatment. These categories will have grades of 50, 70, 85, and 100 in
order to grade each treatment in each category. The treatment with the highest average score
will be deemed the most effective for the majority of Epileptic patients.

Evaluation of Treatments
All of the treatments mentioned were graded according to the rubric. The first treatment
was drug therapy. Drugs scored a 85 in long term effectiveness because they were able to
reduce the frequency of seizures by about 80% in the majority of Epileptic patients. As far as
cost, drug treatment received a score of 100 because the drugs range from a cost of $110-$460
based on which medication is prescribed for the patient. This is on the lower end of the
spectrum for cost. The drug treatment was then evaluated for side effects. It received a score of
85 because initially, the patient will have some side effects, but as the use of medication
continues, the patient will become accustomed to the medication, and the occurrence of side
effects will drastically reduce. The patient will then be able to lead a high quality lifestyle. The

ORIGINAL WORK

final category that drug treatment was evaluated for, was duration of treatment. It received
score of 50. Some patients will have to be on medication for a few years, and some will have to
be on it lifelong. While a patient is on the drug treatment, he/she will have minimal issues, but
the seizures will typically come back if medication is stopped abruptly. The average score for
drug treatment was an 80. The next treatment evaluated was surgery. It scored an 85 for long
term effectiveness. Typically, people who have to resort to surgery will often become seizure
free, or have a drastic reduction in seizures. However, these surgeries are only performed on
those who have partial seizures. Surgery scored a 50 in cost. On average, surgery can cost about
$12,000, which is not very cost friendly for most epileptic patients. The next category was side
effects, and surgery scored a 50. There are many risks associated with it, and it can result in long
term neurological effects that can significantly lower the patients quality of life. The final
category was duration of treatment, and surgery scored a 100. Patients have the surgery and do
not have to wait long to see the results. The total average score for surgery was a 71.25, which
was rounded to a 71. The final treatment evaluated was the ketogenic diet. It scored a 70 in long
term effectiveness. It is noninvasive, but does not have suitable results for each patient. The
success rate is 50%. As far as cost, the diet scored a 70. It is expensive in the sense that a
dietician will have to be hired to come with meal plans. The high fat food can also be expensive.
For the next category of side effects, the diet scored a 70. It has some minor side effects, but
there are some more complicated ones, like bone fractures. The final category was duration of
treatment, and this diet scored an 85. Typically it will take a year to see the results and begin to
gradually slow the use of the diet. The ketogenic diet had an average score of 73.75, which was
rounded to a 74.

Most Effective Treatment

ORIGINAL WORK

10

Based on the evaluation rubric, it is safe to say that the drug therapy, with a score of 80,
proved to be the most effective form of treatment, for adults and children alike. While it is not
necessarily perfect, it is noninvasive, not as expensive, and has few side effects compared to the
other treatments. It has significantly lowered the the occurrence of seizures in the majority of
epileptic patients, and for the most part, patients do not have to be on treatment for their whole
lives. Until newer, and more efficient treatments come along for treating Epilepsy, drug therapy
is a patients best option.

ORIGINAL WORK

11

References
Goldenberg, M. M. (n.d.). Overview of Drugs Used For Epilepsy and Seizures: Etiology,
Diagnosis,
and Treatment. Retrieved February 09, 2016, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912003/
Effectiveness of Treatment. (n.d.). Retrieved February 09, 2016, from
http://www.epilepsychicago.org/epilepsy-facts/treatment/effectiveness-of-treatment/
Search for Research Summaries, Reviews, and Reports. (n.d.). Retrieved February 09, 2016,
from
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?
productid=463
Surgery. (n.d.). Retrieved February 09, 2016, from
http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/surgery
Surgery for Seizures and Epilepsy. (n.d.). Retrieved February 9, 2016, from
http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/treatmen
t/surgery/
Ketogenic Diet. (n.d.). Retrieved February 09, 2016, from
http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-d
iet
Ketogenic diet. (n.d.). Retrieved February 09, 2016, from
http://www.epilepsysociety.org.uk/ketogenic-diet#.VqqIF5orLIU

ORIGINAL WORK

12