Treatments and drugsBy Mayo Clinic staff
Doctors generally start by treating epilepsy with medication. If that doesn't work, they may propose surgery or another type of treatment.
Most people with epilepsy can become seizure-free by using a single anti-epileptic drug. Others can decrease the frequency and intensity of their seizures. More than half the children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.
Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage and may increase the dosage gradually until your seizures are well controlled.
All anti-seizure medications have some side effects. Mild side effects include:
- Weight gain
- Loss of bone density
- Skin rashes
- Loss of coordination
- Speech problems
More severe but rare side effects include:
- Suicidal thoughts and behaviors
- Severe rash
- Inflammation of certain organs, such as your pancreas or liver
To achieve the best seizure control possible with medication:
- Take medications exactly as prescribed.
- Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
- Never stop taking your medication without talking to your doctor.
- Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts or unusual changes in your mood or behaviors.
At least half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies.
Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn't interfere with vital functions like speech, language or hearing. In these types of surgeries, your doctor removes the area of the brain that's causing the seizures.
If your seizures originate in a part of your brain that can't be removed, your doctor may recommend a different sort of surgery in which surgeons make a series of cuts in your brain. These cuts are designed to prevent seizures from spreading to other parts of the brain.
Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your cognitive abilities. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering.
- Vagus nerve stimulation. This therapy involves a device called a vagus nerve stimulator that's implanted underneath the skin of your chest like a heart pacemaker. Wires from the stimulator are wrapped around the vagus nerve in your neck. The battery-powered device delivers short bursts of electrical energy to the brain through the vagus nerve. It's not clear how this inhibits seizures, but the device can reduce seizures by 20 to 40 percent and completely control seizures in about 5 percent of people. Most people still need to take anti-epileptic medication. Side effects of vagus nerve stimulation include hoarseness, throat pain, coughing, shortness of breath, tingling and muscle pain.
Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by maintaining a strict diet that's high in fats and low in carbohydrates. This diet, called a ketogenic diet, causes the body to break down fats instead of carbohydrates for energy. Some children can go off the ketogenic diet after a few years and remain seizure-free.
Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that a child doesn't become malnourished when taking the diet. Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies, and buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if use of the diet is properly and medically supervised.
- Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm. Accessed Feb. 11, 2011.
- Schachter SC. Evaluation of the first seizure in adults. http://uptodate.com/home/index.html. Accessed Feb. 10, 2011.
- First aid for seizures. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/firstaid/index.cfm. Accessed Feb. 11, 2011.
- Frequently asked questions. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/faq/. Accessed Feb. 11, 2011.
- Schachter SC. Overview of the management of epilepsy in adults. http://uptodate.com/home/index.html. Accessed Feb. 11, 2011.
- Ottman R, et al. Comorbidities of epilepsy: Results from the Epilepsy Comorbidities and Health (EPIC) survey. Epilepsia. 2011;52:308.
- Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Neurology. 2010;75:335.
- Prolonged or serial seizures (status epilepticus). Epilepsy Foundation. http://www.epilepsyfoundation.org/about/types/types/statusepilepticus.cfm. Accessed Feb. 12, 2011.
- Schacter SC. Sudden unexpected death in epilepsy. http://uptodate.com/home/index.html. Accessed Feb. 12, 2011.
- Pre-surgical evaluation. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/treatment/surgery/evaluation.cfm. Accessed Feb. 12, 2011.
- Hirsch LJ, et al. Neuroimaging in the evaluation of seizures and epilepsy. http://uptodate.com/home/index.html. Accessed Feb. 12, 2011.
- Karcesky S. Initial treatment of epilepsy in adults. http://uptodate.com/home/index.html. Accessed Feb. 12, 2011.
- Kossoff EH. The ketogenic diet. http://uptodate.com/home/index.html. Accessed Feb. 12, 2011.
- Epilepsy. National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001714. Accessed Feb. 13, 2011.
- Tips for living. Epilepsy Foundation. http://www.epilepsyfoundation.org/about/quickstart/newlydiagnosed/qsliving/idvtips.cfm. Accessed Feb. 14, 2011.
- So E (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 14, 2011.