Epilepsy Treatment

It’s important to start treatment for epilepsy promptly after receiving a diagnosis. People who experience seizures—particularly seizures that aren’t easily managed—often see neurologists that specialize in epilepsy.

Medication is generally the first line of treatment for epilepsy¹⁵. If medication isn’t enough to manage the disorder, your healthcare provider may recommend surgery or another type of treatment. Of people diagnosed with epilepsy, about 70% are able to control their seizures with medication and/or surgery¹⁶.

When medications cause severe side effects or are ineffective in treating their condition, some children may adhere to a specific diet (ketogenic diet) in order to control their seizures.

Epilepsy medication

Most people with epilepsy are able to achieve remission (being seizure-free) by taking just one anti-seizure (or anti-epileptic) medication¹⁷. Some individuals are able to decrease the frequency and intensity of their seizures by taking a combination of anti-seizure medications.

Many adults with epilepsy are able to discontinue their anti-seizure medications after they have had two or more seizure-free years. Many children who have the disorder but aren’t experiencing any symptoms are able to eventually discontinue medications and go on to live seizure-free. Your healthcare provider will work with you to determine the right time to discontinue your anti-seizure medications.

Typically, a healthcare provider will begin by prescribing a single medication at a low dose. They may gradually increase the dose while closely monitoring changes in your signs and symptoms until your seizures are well-managed. Because some medications work best for certain types of seizures for others, the medication that works for you may depend upon the kinds of seizures you experience.

Ultimately, finding the right medication and dosage relies on several factors, including your overall condition; the frequency, intensity, and type of your seizures; your age; and any other health conditions you have.

Anti-seizure/anti-epileptic medications may cause some side effects. Mild side effects may include:

• Fatigue
• Dizziness
• Weight gain
• Skin rashes
• Loss of coordination
• Problems with speech, memory, and thinking
• Loss of bone density

Some rarer but potentially more severe side effects include:

• Severe skin rash
• Depression
• Suicidal thoughts or behaviors (If you or someone you know is exhibiting suicidal thoughts or behaviors, please call the National Suicide Prevention Lifeline at 1-800-273-TALK. You can also visit suicide.org to find a phone number to call in your country)
• Inflammation of certain organs, such as the liver (hepatitis)

In order to achieve the most effective results from your anti-seizure medications, practice the following:

• Take medications exactly as directed by your healthcare provider
• Never discontinue use of your medication without consulting your provider
• Always inform your provider before switching to a generic version of your medication or before taking over-the-counter drugs, natural remedies, or other prescription medications
• Talk to your healthcare provider immediately if you notice any new or worsened signs of depression, suicidal thoughts, or unusual changes in your mood or behavior
• Inform your provider if you have migraines (they may be able to prescribe an anti-seizure medication that can prevent migraines while still testing your epilepsy)

Your provider may prescribe the following medications for epilepsy:

In November of 2019, the United States Food and Drug Administration (FDA) also approved cenobamate tablets (generic Xcopri) to treat partial-onset seizures (which may cause impaired consciousness or a total loss of consciousness) in adults¹⁸.

At least half of individuals newly diagnosed with epilepsy are able to become seizure-free on their first medication. If anti-seizure medications aren’t effective in treating your epilepsy, your provider may suggest surgery or an alternative therapy.

Epilepsy surgery

Surgery for epilepsy involves removing the area of the brain that’s causing seizures. This may be an option if anti-epileptic medication isn’t effective in adequately managing your seizures.

Healthcare providers usually recommend surgery for epilepsy when diagnostic testing reveals that:

• Your seizures occur in a small, well-defined area of your brain
• This area isn’t responsible for vital functions such as vision, hearing, speech, language, or motor function

Even when surgery is successful, many people with epilepsy need to continue taking some medication to help prevent future seizures. However, undergoing surgery may allow you to take fewer medications and reduce your dosages.

While rare, surgery to treat epilepsy can lead to serious complications, such as permanently altering your cognitive abilities. Ultimately, talk to your specialist and surgeon about their experiences, success rates, and the possibility of complications with the procedure you’re considering.

Other therapies for epilepsy

Aside from medication and surgery, other potential therapies may be effective in treating epilepsy, including¹⁹:

• Deep brain stimulation: This procedure involves implanting electrodes into a specific area of your brain (typically, the thalamus) and sending electrical impulses from a generator implanted in your chest or skull.

• Vagus nerve stimulation: In vagus nerve stimulation, a device (called a vagus nerve stimulator) is implanted underneath the skin of the chest. Wires are then connected from the stimulator to the vagus nerve (found in the neck), and the device sends bursts of electrical energy through the nerve to the brain.

  This method typically reduces seizures by 20–40%. While most people who undergo vagus nerve stimulation still need to take anti-seizure medication, some are able to lower their dosage.

• Ketogenic diet: Some children with epilepsy (especially those for whom medication is ineffective or causes serious side effects) have been able to reduce the frequency of their seizures by following a particular diet. This diet, called the ketogenic diet, is high in fats and low in carbohydrates. After a few years of following this diet, some children may be able to return to their normal eating habits (under close medical supervision) and remain seizure-free.

  As always, it’s important to talk to your child’s healthcare provider before making any drastic changes to their diet. Some potential side effects of a ketogenic diet include constipation, dehydration, and delayed growth (due to nutritional deficiencies and/or a buildup of the waste product uric acid in the blood, which can lead to kidney stones). However, these side effects are uncommon in children whose diets are closely and medically supervised.

Along with these therapies, researchers are studying many potential new treatments for epilepsy, including minimally invasive surgeries like MRI-guided laser ablation and external nerve stimulation.

Seizure first aid

If your child or a loved one has epilepsy, it’s important that you understand what to do if they have a seizure. Because there are many different types of seizures, you may need to follow specific steps in dealing with your loved one’s particular type of episodes.

Some general steps you can take to help someone having any type of seizure include²⁰:

• Remaining with the person until their seizure ends and they are fully awake. After the seizure ends, help them sit up in a safe, comfortable place. Once they’ve regained awareness and are able to communicate, explain what happened to them simply and clearly.
• Checking to see whether the person is wearing a medical bracelet or has any other emergency medical information
• Comforting the person and speaking in a calm, reassuring tone
• Remaining calm and helping others stay calm
• Making sure the person gets home safely by offering to call a taxi, giving them a ride, or finding a friend or family member to drive them home

When most people picture a seizure, they think of a tonic-clonic seizure (previously referred to as a grand mal seizure), during which the person may fall, jerk, shake, cry out, and lose awareness of their surroundings.

To help someone having a tonic-clonic seizure:

• Prevent injury by clearing the surrounding area of hard, sharp, or otherwise dangerous objects
• Ease them down onto the floor
• Help them breathe by turning them gently onto one side
• Cushion their head with something soft and flat, like a folded sweater or blanket
• Remove eyeglasses, if necessary
• Loosen or remove anything around the neck that may make it hard to breathe, such as a tie or necklace
• Time the seizure and call 911 if it lasts for more than five minutes

Most seizures don’t require emergency medical care. You only need to call 911 if one or more of the following are true:

• The person has never had a seizure before
• The seizure lasts for more than five minutes
• The person has difficulty awaking or breathing after the seizure
• The person has another seizure shortly after the first one
• The person is injured during the seizure
• The person has a chronic health condition (such as diabetes or heart disease) or is pregnant
• The seizure happens in water

Never do any of the following while a person is having a seizure:

• Hold them down or try to stop their movements
• Attempt to give mouth-to-mouth resuscitation breaths (like CPR), as people usually begin breathing again on their own after a seizure
• Put anything in their mouth, as this can injure the teeth or jaw. A person having a seizure can’t swallow their tongue.

While it may seem helpful, do not offer a person who has just had a seizure water or food until they are fully conscious and alert.