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30-50 percent of patients, al-
though it also interacts with oth-
er medications.
In 1978, carbamazepine (Teg-
retol) was approved and showed
a significant advancement over
previous drugs for controlling
seizures.
"In the last six or seven years,
more antiepileptic drugs have
been produced than in the last
90 years," Dr. Spitzer says.
Among the more potent and
effective is felbamate (Felbatol),
approved by the Federal Drug
Administration in early 1993.

Mr. Becker was reluctant to be
interviewed and declined to be
photographed.
"It's not difficult to recognize
why epilepsy retains its nega-
tive stigma," says Dr. Spitzer,
"even with all of the medical ad-
vances for treating the disease.
I suspect it's because something
like 50 percent of patients with
epilepsy are mentally impaired.
"What people don't know is
that it is a brain disease or sig-
nificant brain damage which
caused the impairment as well
as the epilepsy. It is not epilepsy

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Brain waves during a seizure.

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Because patients need to be
carefully monitored with blood
tests, most physicians don't use
this drug as a first choice. But
for a small number of patients,
it's the only drug that works.
Around the same time,
gabapentin (Neurontin) was
made available. Although it isn't
very potent, it has few side ef-
fects and seldom interacts with
other medications. This makes
it safe for people who take med-
ications for other chronic ill-
nesses, especially the elderly.
Other new drugs include
gabapentin (Neurotin), useful
when combined with other med-
ications, and Lamotrigine (lam-
ictal), which is more potent but
sometimes causes a severe skin
rash.
The latest agent is topiramate
(Topamax) as an adjunctive
therapy for adult patients with
partial onset seizures.
"No single drug controls all
types of seizures and different
patients require different drugs,"
says Dr. Spitzer. "Choosing the
best antiepileptic drug is now
more challenging because there
are more new drugs available
and the exact role of these drugs
for each seizure type or syn-
drome hasn't been established."
"On the other hand, patients
have a better chance of control-
ling their seizures 100 percent
because they have more op-
tions."
Epilepsy affects an estimated
one percent of the U.S. popula-
tion — 2.5 million people.
Patients and families don't
like to talk about epilepsy. Even

which causes the impairment.
"Even so, it's difficult to find
someone who has epilepsy that
understands it well enough to
talk about it and can articulate
how it has impacted their life.
Scott Becker is the exception. Al-
though medication has not
worked completely for him, there
is hope that he is a candidate for
a surgical procedure that will
work."
Mr. Becker is among the 20
percent of people with epilepsy
for whom drugs don't completely
control seizures. For him, an op-
eration to remove the problem-
atic portion of the brain is an
option.
This treatment was used
more than a century ago but not
performed widely until the past
20 years because of the advances
in recording brain activity with
an electroencephalogram (EEG).
Electrodes, either on or beneath
the scalp, make it possible to pin-
point the abnormal `raring" from
the disturbed brain cells. Im-
proved visualization techniques,
such as magnetic resonance
imaging (MRI) and positron
emission tomography (PET),
also reveal information about
the size an:If-unction of specific
brain areas to guide doctors.
Technology has made it pos-
sible to precisely localize the fo-
cus of seizure activity in the
brain by eliminating the damp-
ing effects of recording electrical
activity through the dense skull
bone.
Says Dr. Spitzer, "This type
of surgery works best when it is
known that the damaged area is