I was in transportatin when one of the passengers suddenly had an epileptic seizure that lasted for about four minutes. My mom is a physician and she told me that epileptic seizures can be completely avoided if the patient is on medication. I don't think this patient isn't on medication, can be there any condition where epileptic seizures take place alongwith the medications ?
Dear Sherouk, unfortunately antiepileptic drugs only lower the probability of having a seizure but do not completely abolish them. In some forms of epilepsy and in some patients, the treatment can be so effective to prevent all seizures. In other individuals, with different epileptic syndromes, the drugs may have only partial efficacy. For the concept of pharmacoresistant epilepsy you could refer to this paper:
http://www.sciencedirect.com/science/article/pii/S2212822013000021
Dear Sherouk, epilepsy is an illness, a process, characterized by seizures. Unfortunately, seizure inhibitory drugs or even surgical interventions are able to result seizure freedom only in 70% of the patients. But in any case when sizures occurring beside adequat pharmacotherapy, we can suppose some actual biological or other precipitating / provocing factors, too.
Sometimes anti-epileptic medication response is not as good as expected. There is no rule such as "when you take your anti-epileptic drugs you will have no seizures". Thats why there is a term "drug resistant epilepsy".
Dear Sherouk
Seizures are built-in activities, i.e. you can trigger a seizure in any "healthy" neuronal network provided that you exert a "force" strong enough. This is true from flies to humans, and seizure dynamics follow universal rules across species and brain regions.
http://www.ncbi.nlm.nih.gov/pubmed/24919973
Give an electroshock to anyone, and this person will have a seizure no matter what. The probability to have one seizure during one's life is 1/17. It all comes down to crossing a threshold for seizure genesis. In a "healthy" individual, the threshold is high. In a patient, it is lower, hence the seizure probability in increased. As Luigi mentioned, the antiepileptic drugs increase the threshold, hence decrease the probability. Drug are not efficient in 30% of the patients.
Dear Shorouk
There are many seizures type, in this case the generalized seizures are the most difficult for treated. Unfortunately there are many cases of people who do not respond to drug therapy very well. There are other non pharmacological treatments when medication fails. However those are very costly and also need to be candidates for surgery (free of further damage) . Some times like said Irfan Ali, poor sleep hygiene and appetite are causes for seizures control in the patient.
Dear Shorouk, unfortunately only a Little more than 50-60% of Patients will be permanently seizure free with antiepileptic drugs, even when taken regularly. Taking into consideration that the prevalance of Epilpsy is (worldwide) close to 1%, the probability of meeting someone with uncontrooled epilepsy is small but not extremely small. In a town of 10.000 People, you´d have 40-50 People with uncontrolled epilepsy. But even People with well controlled epilepsy are at risk for seizures, for instance when suffering from diarrhea (no or insufficient uptake of the drugs from the intestine) or sleep deprevation, both possible prolems when travelling. So you witnessed what is the reality for many People with epilepsy, the seizures are a heavy burden especially if taking place in public or if associated with injury, even when they are short and seldom.
The answer is that the probability of a seizure is multifactorial. The main issues are:
genetic disposition to seizures in general (i.e., epileptic threshold) which varies from individual to individual
genetic causes of individual types of epilepsy or seizure types (e.g. nocturnal frontal lobe epilepsy)
poor choice of type or types of anti-epileptic medication
insufficient dose of anti-epileptic medication(s)
lack of full compliance to an adequate chemotherapeutic regime
presence of triggering factors in so-called "reflex epilepsies" (by visual, auditory, somesthetic or olfactory stimuli)
sleep deprivation
presence of chemicals which reduce seizure threshold
presence of organic brain disease with epileptic focus or foci requiring surgical extirpation
no doubt there are others which, for the moment, escape me
Roger Broughton MD, PhD, FRCPC, Professor Emeritus of Neurology, Univ. of Ottawa
Co-author with Henri Gastaut of the volume "Epileptic Seizures" and past-expert for epilepsy at the World Health Organization
There are a variety of factors involved in the development of seizures wherein epileptic threshold decreases ( i.e. neuronal threshold potential comes nearer to neuronal resting membrane potential in the affected area) and /or the neuronal resting membrane potential increases towards threshold level (i.e. neuronal resting membrane potential becomes less negative), or both threshold voltage and resting membrane voltage are affected. Hyperexcitabilty occurs in these occasions that may lead to focal/ partial seizure. Generalization in the spreading of hyperexcitability elicits generalized seizures. Drug withdrawal effects might be more serious causing intractable seizures. In certain cases, patients take the prescribed drugs regularly, but the blood levels of the drug are not appropriate. In other cases, drugs are not absorbed appropriately due to absorption disorders.
Proper diagnosis and differential diagnosis, prescription of the drug/ drugs of choice, and monitoring blood levels of drugs and epileptic features have much importance for the proper management of seizures. Appropriate drugs should be prescribed for specific seizure types. Anticonvulsants/ antiepileptic drugs can increase the seizure threshold level but cannot always abolish the seizure occurrence.
Various other factors changing the epileptic threshold or neuronal excitability have been explained in above by several researchers.