(from the Epilepsy Program at Neurological Surgery P.C.)

Diagnosis:

• How confident are we about the diagnosis? Could it be something else?
• What etiologies are suspected and how are they being further clarified?

Precipitants and Precautions:

• What precautions should I take to reduce the chances of a seizure?
• What should I do if a dose of medication is missed?
• What is the role of stress?
• Can I drink alcohol?
• Can the patient take herbs or other alternative medicine treatments?

Tests:

• What tests are indicated?
• What are the different types of EEG testing and which one is indicated? (e.g. sleep-deprived routine EEG, inpatient video-EEG, ambulatory EEG)
• Is lumbar puncture or pictures of the brain indicated?

Treatments:

Medications:

• Is a medication necessarily needed?
• Why was this specific treatment selected? What other choices were considered and what are their advantages and disadvantages?
• What can I reasonably expect to achieve by taking this drug?
• What specific side effects should the patient be on alert for? When should the physician be notified? What precautions can be taken to reduce the chances of side effects?
• How does the current antiepileptic drug affect my mood? Are there any alternative medications that may help my mood?
• How long will it take to know that the drug is working?
• Blood levels: When, why and how medication levels should be checked? Discuss schedule and reasoning behind checking blood counts and chemistries.
• Is an extended-release form of the drug indicated?
• What should be done if a medication dose is missed?
• What will be done if the antiepileptic drug doesn't work?
• Drug interactions
• Benefits and deficits of generic vs. brand formulation
• Cost considerations
• How long will the patient be on this antiepileptic drug? Can the drug be discontinued?
• Are there any investigational trials that should be considered?
• Is the patient compliant with medications?

Surgery for Epilepsy:

• Surgical options (e.g., resective surgery, corpus callosotomy, vagal nerve stimulation)
• Am I a candidate for surgical treatment?
• What does an evaluation for epilepsy surgery entail?
• What can be expected from epilepsy surgery?
• What are the risks?
• What is the vagal nerve stimulator?

Other Treatments:

• Ketogenic diet?
• Do herbal treatments work?
• Acupuncture and relaxation therapy?

Prognosis:

• Will epilepsy be a life-long condition? Will medications be needed for the patient?s entire life?
• Risks of subsequent epilepsy in children with febrile seizures.
• What are the chances of recurrence after a single seizure?
• Is the seizure harmful?
• If the patient has been recently seizure-free, what are the chances of remaining seizure free? Can medication be reduced or eliminated?

First-aid (download list of safety tips from seizureli.com) :

• What should the patient or others do if a seizure occurs?
• Does a seizure recurrence necessarily warrant going to the emergency room?
• Should the patient inform the physician about every seizure?

Impact of Epilepsy on Lifestyle:

• What activities should be restricted?
• Can I drive? How long do I  need to be seizure-free until driving is permitted?
• Do I need to report information to the state department of motor vehicles?  Does the doctor need to do this?

Questions about the psychological impact of epilepsy and its treatments would include:

• What should I do if I feel depressed or anxious? Should I be seen by a specialist for this?
• Is there a risk of lowering of the seizure threshold with a medication that my psychiatrist has prescribed? 
• Could mood or behavioral problems be related to an antiepileptic therapy? Is a change in treatment indicated because of this?
• Discuss areas of possible sexual difficulties such as fear of intimacy, lack of sexual drive, difficulty attaining erection or orgasm.

Pregnancy issues:

• What do we know about the risk of birth defects with current or future recommended antiepileptic agents?
• What is the nature of the potential birth defects?
• What can be done to lower these risks?   
• Can I breast-feed?

Additional resources:

• What additional resources are available to help the patient learn more about epilepsy?
• What societies or foundations can help the patient by advocating for legal rights, obtaining insurance, and benefits?

 

 

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