TREATMENT: old and new
Seven newer anti-epileptic drugs are now available, with two more in the pipeline. They include gabapentin, lamitrogine and vigabatrin.
Generally, these newer drugs have the advantage of being easier to tolerate. Most can be given once or twice a day and, unlike the older drugs, they do not compete for space in the liver, leading to less drug interaction.
Common side-effects of medication for epilepsy include tiredness, difficulty concentrating and dizziness. Phenytoin, an older drug, causes gum swelling while the commonly used sodium valproate is associated with weight gain.
Of the newer agents, vigabatrin can cause damage to the retina (of the eye).
The general aim of treatment is to choose the best drug for the particular type of seizure and to try to gain control of the convulsions with a cocktail of three drugs or less.
Brain surgery has a role in those who continue to have uncontrolled seizures.
The most common operation is the removal of part of the temporal lobe of the brain, called the hippocampus. Epilepsy surgery is carried out at Beaumont Hospital by Prof Jack Phillips.
For those who are not suitable for surgery, but who continue to have uncontrolled seizures, a technique called vagal nerve stimulation (VNS) may help. A small device is implanted under the skin in the chest wall and a lead is connected to the vagus nerve in the neck. While the exact mechanism of action remains unclear, VNS cuts the number of seizures by half in 40 per cent of those treated.
The non-drug treatment of epilepsy is important and includes education and lifestyle advice.
RESEARCH: patient records
There are several epilepsy research projects under way at Beaumont Hospital.
Health Research Board (HRB) funding of 230,000 is driving research into an epilepsy electronic patient record (EPR).
Under the direction of principal physicist Mary Fitzsimons and in collaboration with the hospital's IT department,Trinity College and the Dublin Institute of Technology, the aim is to create an electronic record for every patient with epilepsy.
"The introduction of the epilepsy EPR can improve the efficiency of current resources," Fitzsimons says.
She points out that such a record will allow a range of healthcare professionals track the progress of a patient's investigations and treatment.
The Brain Morphometry Laboratory of the Royal College of Surgeons in Ireland is located at Beaumont. Using brain MRI scans, it is studying the basic mechanisms underlying seizure activity.
According to Dr Colin Doherty, senior lecturer in neurology, the research is attempting to quantify the many levels of information displayed by the brain, including its volume, size and wiring patterns.
"The MRI of each brain is recreated in three dimensions and analysed on powerful computers to see if any of the characteristics are abnormal, thereby giving clues to the disease," he says.
Other research includes a Higher Education Authority- funded project on pharmacogenomics, aimed at identifying genetic factors which could better predict an individual's response to epilepsy medication.
Beaumont is also the location for the Irish Epilepsy and Pregnancy Register and nursing research into patient satisfaction with epilepsy care.