The use of anti-epileptic drugs is clearly the principal method of treating epilepsy. In those situations where a specific cause for the seizures has been found, then other treatments may be necessary. This will include antibiotics if the cause is meningitis or a cerebral abscess, antiviral drugs for certain types of encephalitis caused by viruses, supplementation of the diet with vitamins or other substances in those rare disorders where there may be a deficiency, and the use of surgery to remove cysts, tumours, or abnormal areas of the brain. Counselling and other specific psychological programmes designed to help modify behaviour may also be required for certain people, including those who drink alcohol to excess, or who use illicit drugs.
Dietary manipulation-There have been a number of attempts to control epileptic seizures by modifying the diet. This arose from the observation many years ago that fasting or starvation seemed to be associated with a reduction in the frequency of seizures. In the fasting state, normal metabolism is altered with the appearance of substances in the blood and urine, called ketones. It is not known how or why ketones are linked with seizure control. Of course, there may be no direct relationship between the two, and the occurrence of the two together may be coincidental. A diet was discovered which produced ketones, but without the child having to be starved. The diet is very rich in fat and oils, which makes it rather unpalatable. Because 70 per cent of the diet is in this fat form (the remaining 30 per cent coming from protein and carbohydrate), extra vitamins and minerals (such as calcium and magnesium) must be given. In spite of all the fat and oil eaten in this diet, there is no change in the blood level of cholesterol which is responsible for causing coronary heart disease. The main disadvantages with this diet are the unpalatability, often unpleasant diarrhoea, and the fact that the diet must be strictly followed. Its use is usually restricted to infants and children with very severe epilepsy (often with the Lennox-Gastaut syndrome). Unfortunately its success is limited and usually short-lived.
A rarely used and less successful diet is oiled the oligoantigenic diet. This entails trying to identify those substances in the diet which may cause an increase in epileptic seizures, and then to exclude them from the diet.
There are few, extremely rare conditions, where the epilepsy is caused by an ‘inborn error of metabolism’. This means that either the body is missing, or is unable to use, a particular substance—usually a vitamin or enzyme, and, as a result the person develops epilepsy, and often other problems (for example, skin rashes, loss of hair, failure to grow). If the missing substance is then given in large doses, then the epilepsy may stop. An example of this is a condition called pyridoxine (vitamin B6)-dependent seizures, which usually begins by affecting babies or infants in the first few days or weeks of life.