How Do You Treat an Atonic Seizure?

How Do You Treat an Atonic Seizure?

Atonic seizures, or "drop attacks", refer to an unexpected and temporary loss of muscle strength caused by interrupted brain electrical activity. Such seizures are usually short-term, lasting a mere few seconds, but they can lead to hazardous falls and injuries.

For a short time during the seizure, an individual can suddenly fall, lose the ability to speak and move, and be momentarily unresponsive. Though most prevalent in childhood, particularly in epilepsy syndromes such as Lennox-Gastaut syndrome, atonic seizures can continue into adult life.

Though incurable, treatments are available that can significantly prevent and improve the condition and quality of life. Keep reading to learn about the treatment for an atonic seizure.

What is the first-line treatment for atonic seizures?

The initial treatment for atonic seizures is sodium valproate. However, for men and women who are infertile, there are established risks in pregnancy. Sodium valproate can effectively decrease the severity and frequency of tonic and atonic seizures.

Other antiseizure drugs, such as lamotrigine, topiramate, levetiracetam, etc., can be used by other people depending on individual risk factors.

What are the key treatment approaches for atonic seizures?

Atonic seizures can be challenging to treat due to their sudden onset and resistance to most conventional treatments. Hence, an individualised approach to therapy is usually needed for adequate control. The following are the most important treatment methods employed:

1.  Medication (Anti-Epileptic Drugs – AEDs)

Atonic seizures, particularly those associated with certain epilepsy syndromes, can be challenging to treat and are often resistant to many standard anti-seizure medications, necessitating a tailored approach. 

Broad-spectrum drugs, such as lamotrigine and topiramate, can also be ideal anti-seizure medications. Rufinamide is also often used, particularly in diseases like Lennox-Gastaut syndrome. Therapy can involve drug combinations and dosage modifications to determine the most suitable treatment.

2.  Dietary Therapy

For patients with drug-resistant seizures, dietary changes may prove an effective therapy. The most notable example is the ketogenic diet, which consists of a high-fat, low-carbohydrate regimen and has proven to be highly effective in paediatric patients.

Other options are the modified Atkins diet and the low glycaemic index treatment. The medical team must monitor all these diets to ensure a balanced intake and reduce risks.

3.  Vagus Nerve Stimulation (VNS)

If medications are not well controlled alone in seizure suppression, VNS can be used. This requires the implantation of a small device under the skin on the chest that delivers periodic electrical impulses to the brain through the vagus nerve. Numerous patients have experienced fewer and less severe seizures over time when used in combination with AEDs.

4.  Surgical Treatment

Surgical treatment is usually limited to patients with focal atonic seizures who are unresponsive to other treatments. Corpus callosotomy is an operation that cuts the link between the hemispheres of the brain, preventing the spread of seizures and decreasing drop attacks.

Sometimes, resective surgery can also be planned if the seizure is limited to one area of the brain and can be safely resected.

5.  Lifestyle and Safety Precautions

Known seizure triggers, such as insufficient sleep, high stress, or missed medication doses, must be avoided. 

Safety measures, such as wearing protective headgear to avoid fatal head injuries caused by falls, can be advised. Other therapies, such as cognitive behavioural therapy and stress management techniques, can also aid in overall health and seizure management.

How to Diagnose Atonic Seizures?

Atonic seizures have subtle or abrupt manifestations, so the diagnosis is conducted in different ways. Here are the major diagnostic approaches:

• Medical History and Review of Symptoms: This vital step involves a meticulous review of symptoms, seizure frequency, duration, and events before and after a seizure.
• Family History: As seizures can be hereditary, the doctor may check the patient's family history, which may support the diagnosis.
• Electroencephalogram (EEG):This is the basic instrument used to determine whether brain wave activity is normal or abnormal. An EEG taken during or after the event can determine the typical pattern of atonic seizures compared to other types of seizures.
• Imaging Tests: MRI (magnetic resonance imaging) or CT (computed tomography) imaging scanning may be helpful in ruling out structural abnormalities, lesions, and focal brain damage that may contribute to seizure activity.
• Blood Tests: Blood tests are ordered to determine metabolic or electrolyte drain, which may put the patient at risk for seizures.
• Cardiac Evaluation: Because sudden collapse can also be caused by heart conditions (syncope), tests like an ECG or Holter monitor are often used to rule out cardiac arrhythmias as a mimic of atonic seizures.

Management of atonic seizures is a multifaceted process that includes medications, diet changes, device treatments, and, in some cases, surgery. Proper support enables individuals with atonic seizures to live more stable and safer lives. It is also advised to have health insurance to protect your health and finances during critical times.