How Epilepsy Is Treated

Epilepsy is usually treated with medications, but it may also involve surgery, nerve stimulation devices, or special diets, depending on your situation and whether or not your seizures are controlled with medication. There are multiple new treatments on the horizon for epilepsy as well. Regardless of the treatment course followed, the end goals are the same: to allow you to live your fullest life, prevent seizures, and minimize the effects of managing your disorder. Finding the right path for you can take some time.

Prescriptions

If you're diagnosed with epilepsy, your doctor will most likely first prescribe anti-seizure medication (antiepileptic drugs) to control your seizures. Most people's seizures can be controlled with just one medication, but some people may need more.

The kind and dosage your doctor prescribes for you will depend on many factors such as your age, what kind of seizures you have, other medications you're taking, and how often you have seizures. It can take some trial and error to find the best drug and dosage with the least amount of side effects for you.

Keep in mind that side effects may go away after you've been on the medication for a week or two and your body has had a chance to adjust. If they don't go away or if they're severe or extremely bothersome, talk to your doctor right away.

With many medications, missing a dose or two isn't terribly serious. However, missing even a single dose of your anti-seizure medication can cause you to lose control of your seizures. This is why it's extremely important to take your medication exactly as prescribed and talk to your doctor if you're having any difficulties with your medication.

Many people are able to control their seizures with antiepileptic drugs and eventually stop taking them after a certain number of years of having no seizures. Stopping your anti-seizure medication too early or on your own can create serious problems, so be sure to work with your doctor on deciding if and when to stop treatment.

There are more than 20 different types of antiepileptic drugs available, including:

  • Tegretol, Carbatrol (carbamazepine): Used for children and adults, carbamazepine is also used to treat pain in conditions like neuropathy and trigeminal neuralgia. Common side effects include dizziness, abnormal thinking, trouble speaking, tremor, constipation, and dry mouth.
  • Onfi (clobazam): This sedative is usually used along with other medications to treat children and adults with Lennox-Gastaut syndrome or other severe forms of epilepsy. Common side effects are fatigue, coordination difficulties, problems speaking or swallowing, drooling, appetite changes, vomiting, constipation, and cough.
  • Keppra (levetiracetam): This is one of the more commonly used antiepileptic drugs to treat adults and children. It can be used alone or with other medications. Common side effects include weakness, coordination problems, headache, dizziness, confusion, aggressive behavior, diarrhea, constipation, excessive sleepiness, loss of appetite, double vision, and neck or joint pain.
  • Dilantin (phenytoin): One of the oldest anticonvulsants, phenytoin can be used alone or with other medications for both adults and children. Common side effects are problems falling or staying asleep, increased blood sugar, abnormal eye movements, tremor, coordination problems, confusion, dizziness, headache, constipation, and gingival hypertrophy (enlargement of the gums).
  • Depakote, Depakene (valproic acid): Used alone or with other medications for children and adults, valproic acid treats absence seizures, generalized tonic-clonic seizures, and myoclonic seizures. Common side effects include drowsiness, dizziness, headache, diarrhea, constipation, appetite changes, tremors, blurry or double vision, hair loss, mood swings, and coordination problems.
  • Neurontin (gabapentin): Gabapentin is used to prevent seizures, treat restless legs syndrome, and ease neuropathic pain. Common side effects are weakness; tremors; blurry or double vision; coordination problems; swelling in your hands, arms, legs, ankles, or feet; and back or joint pain.
  • Phenobarbital: As one of the oldest anticonvulsants, phenobarbital is a barbiturate that's also one of the best understood and researched medications. It's used alone or with other medications in adults and children. Common side effects include drowsiness, headache, dizziness, increased activity, nausea, and vomiting.
  • Mysoline (primidone): Primidone is used alone or with other medications to treat epilepsy, often in children. Common side effects include clumsiness, drowsiness, dizziness, fatigue, coordination problems, loss of appetite, double vision, nausea, and vomiting.
  • Topamax, Trokendi XR, Qudexy XR (topiramate): Used alone or with other medications, topiramate is used to treat generalized tonic-clonic seizures and focal seizures. It's also used along with other medications to treat seizures in people with Lennox-Gastaut syndrome, as well as to prevent migraines. Common side effects include lack of appetite, weight loss, dizziness, tingling in the hands, tremors, drowsiness, and impaired concentration.
  • Trileptal (oxcarbazepine): This medication is used alone or with other drugs in adults and children. Common side effects include stomach pain; nausea; vomiting; uncontrollable eye movements; sleepiness; a change in walking and balance; diarrhea; dry mouth; and problems speaking, thinking, or concentrating.
  • Gabitril (tiagabine): Tiagabine is usually used to treat focal seizures in children and adults. Common side effects are dizziness, drowsiness, coordination problems, mood changes, concentration problems, and difficulty falling or staying asleep.
  • Lamictal (lamotrigine): Used to treat seizures in both children and adults, lamotrigine is also used to treat bipolar disorder. Common side effects include drowsiness; coordination problems; blurry or double vision; headache; nausea; vomiting; diarrhea; constipation; appetite loss; weight loss; tremors; indigestion; weakness; rash; and stomach, back, joint, or menstrual pain.
  • Zarontin (ethosuximide): This medication is used to treat absence seizures in children and adults. Common side effects include nausea, diarrhea, appetite loss, weight loss, hiccups, drowsiness, dizziness, headache, and concentration difficulties.
  • Zonegran (zonisamide): Zonisamide is used with other medications to control seizures. Common side effects are nausea, weight loss, diarrhea, constipation, heartburn, dry mouth, headache, dizziness, confusion, fatigue, and double vision.
  • Klonopin (clonazepam): Belonging to the benzodiazepines class of drugs, clonazepam is a sedative used alone or with other medications to treat seizures. Common side effects are drowsiness, dizziness, slurred speech, coordination problems, blurry vision, urinary retention, and sexual issues.
  • Briviact (brivaracetam): This is a newer medication that was approved in 2016 to treat focal seizures, usually along with other medications. Common side effects include dizziness, gait imbalance, sleepiness, nausea, and vomiting.
  • Aptiom (eslicarbazepine): This medication is also used along with other medications to treat focal seizures. Common side effects are blurry or double vision, dizziness, sleepiness, fatigue, sluggishness, and balance difficulties.
  • Fycompa (perampanel): Perampanel is used for children and adults who are 12 years or older alone or with other medications for focal seizures and as an additional medication for people with generalized tonic-clonic seizures. Common side effects include dizziness, drowsiness, headache, nausea, constipation, vomiting, headache, and balance problems.
  • Epidiolex (cannabidiol): In 2018, the U.S. Food and Drug Administration (FDA) approved the use of Epidiolex, a cannabis-based oil also known as CBD, to treat the severe seizures associated with Lennox-Gastaut syndrome and Dravet syndrome in patients who are 2 years or older. It's taken orally and doesn't contain tetrahydrocannabinol (THC), the chemical that causes a high. This is the first FDA-approved drug that's derived from cannabis (marijuana). When used along with other medications in studies, Epidiolex was shown to help reduce the frequency of seizures in patients with these two syndromes, which are notoriously difficult to control. Common side effects include drowsiness and lethargy, an elevation in liver enzymes, decreased appetite, diarrhea, rash, fatigue, weakness, sleep difficulties, and infections.

    Generic Medications

    If you're wondering about taking the generic form of a medication instead of the brand name or switching from one brand of generic to another, you're not alone. In the United States, nine out of 10 filled prescriptions are for generics. However, generic antiepileptic medications are associated with some issues. Though they contain the same active ingredient as brand names, the inactive ingredients in generics may vastly differ between brands. The amount of medication that your body absorbs may also differ from brand to brand or, though uncommon, you may be allergic to a certain inactive ingredient.

    In order for generics to be approved by the FDA, they must be between 80 percent and 125 percent as effective as the brand name. For some people with epilepsy, this variance can lead to breakthrough seizures (a seizure that happens unexpectedly in someone who normally has good seizure control) or increased side effects.

    The Epilepsy Foundation advises caution when switching from brand name to generic medications or switching between generic brands. For people with seizures that are difficult to control, going with a generic version probably isn't a good idea. However, if your seizures are generally well-controlled, a generic will likely be safe; just make sure that you talk to your pharmacist about getting your medication from the same manufacturer every time.

    Always talk to your doctor before making the jump to another brand or manufacturer to make sure he or she is aware and approves. One option may be to have your doctor look at the medication level in your blood before and after you switch to make sure you're staying on a therapeutic level and to adjust your dose or put you back on the brand name if not.

    Surgeries

    In about 30 percent of people with epilepsy, two or more medications, together or separately, fail to control seizures—what's known as drug-resistant or refractory epilepsy. If this happens to you, your doctor likely will discuss other ways of keeping your seizures at bay, one of which may be surgery. Surgery is recommended when you have a brain lesion, tumor, or mass that's causing your seizures, as well as when you have focal seizures (only occurring in one part of your brain) that aren't controlled with medications.

    The right surgery for you will depend on what type of epilepsy you have, as well as the results of your pre-surgical evaluation and testing. This evaluation and testing helps your doctor locate where your seizures are originating and see how surgery may affect your everyday activities. Testing may include electroencephalograms (EEGs), imaging tests to check for tumors or abscesses, and functional neurological testing to make sure that the surgery doesn't affect abilities such as speaking and reading.

    Surgery always has risks, so these must be weighed along with the benefits. For many people, surgery can significantly reduce or even stop seizures, but it may not help some people at all. Other risks include changes in your personality or your ability to think, though this isn't common.

    If you do have surgery, even if you're seizure-free, you'll still need to take antiepileptics for at least two years. Surgery may also make it possible for you to take fewer medications and/or reduce your dose.

    There are four types of surgery for epilepsy:

    Lobectomy

    Removing the part of the brain in which seizures start is called a lobectomy and it's the most common type of surgery for epilepsy. A lobectomy can only be performed if you have focal seizures that start in one area of the brain.

    Removing part of the temporal lobe of the brain, called a temporal lobectomy, is the most common kind of lobectomy since most types of focal epilepsy are temporal. This surgery has a high success rate with many patients having a reduced frequency of seizures or becoming seizure-free. Though medication may still be needed, it's usually less.

    With a frontal lobectomy, part of the frontal lobe is removed. This is the second most common type of surgery for epilepsy, but it doesn't have quite the same success rate. Still, most patients do have better seizure control after surgery and some do end up seizure-free.

    Multiple Subpial Transection

    When your seizures start in an area of the brain that can't be taken out, you may have multiple subpial transections. In this procedure, the surgeon makes shallow cuts in your brain's cerebral cortex that can help lessen or stop seizures that come from the cerebral cortex while keeping all of your normal abilities intact. This procedure has been shown to be successful, at least temporarily, for Landau-Kleffner syndrome—a rare epilepsy syndrome.

    Corpus Callosotomy

    The brain is made up of two halves, or hemispheres: the right and the left. The corpus callosum is the part of the brain that connects and facilitates communication between them. However, the corpus callosum isn't necessary to survive.

    In a corpus callosotomy, the corpus callosum is severed either two-thirds of the way or completely, disconnecting the two sides and lessening or stopping communication between hemispheres. This can stop certain types of seizures and reduce the frequency of others. This surgery is mostly done in children whose seizures start on one side of the brain and spread to the other. Usually, your surgeon will cut the front two-thirds first and, if this doesn't decrease the frequency of your seizures, the rest may be severed later.

    One side effect of a corpus callosotomy is being unable to name objects that are presented on the left side of your visual field, even if they're familiar. Another possible outcome is called alien hand syndrome, in which you lose the ability to recognize and consciously control a part of your body, such as your hand. The body part may move on its own as well.

    Though this surgery can greatly reduce the frequency of seizures, it doesn't stop the seizures in the hemisphere in which they start, and focal seizures may be even worse afterward.

    Hemispherectomy

    Hemispherectomy is one of the oldest surgical techniques for epilepsy. It involves disconnecting areas of the brain and removing tissue to reduce seizures. In the past, this also involved removing most or all of the hemisphere, but the procedure has evolved over time.

    This surgery is usually used for children, but it can be helpful for some adults too. A hemispherectomy is only performed if your seizures involve just one side of your brain, they're severe, and the same hemisphere isn't functioning well anyway due to damage from injury or seizures, such as that associated with Rasmussen's encephalitis.

    The two most common types of hemispherectomy include:

    • Anatomical: In this procedure, the frontal, parietal, temporal, and occipital lobes are removed from the hemisphere that's causing seizures while keeping the brain stem, basal ganglia, and thalamus in the same place. It's the most extreme form, and there may be some loss of abilities, but people who have this surgery are often able to function well.
    • Functional: This procedure involves removing a smaller section from the hemisphere that's responsible for causing seizures and disconnecting the corpus callosum.

    Both types result in 70 percent of patients becoming completely seizure-free. For patients who still have seizures after surgery, antiepileptic medication may be needed, but the dosage may be less than it was before surgery, resulting in fewer side effects. Seizures rarely get worse after this surgery. Sometimes, a repeat hemispherectomy is needed and the outcome for this is also typically good. 

    Specialist-Driven Therapies

    If surgery isn't an option for you for because you're not a good candidate or you simply want to try another alternative first, there are other treatments to consider. These specialist-driven therapies are all adjunctive treatments, meaning that they are additions to drug therapies—not replacements for them.

    Vagus Nerve Stimulation

    Vagus nerve stimulation, also known as VNS therapy, is FDA-approved to treat seizures in adults and children 4 years and older whose seizures aren't controlled after trying at least two medications.

    Similar to a pacemaker, a vagus nerve stimulator is a small device that's implanted under the skin on your chest that has a wire that runs to the vagus nerve in your neck. It's unclear how it works exactly, but the stimulator delivers regular electrical pulses through the vagus nerve to your brain, lessening the severity and frequency of seizures. It's also possible that you won't need as much medication as you did before VNS therapy.

    On average, VNS therapy reduces seizures by 20 percent to 40 percent and improves quality of life, too. Vagus nerve stimulation reduces seizures more effectively as time goes on. One review found that within four months after implantation, 40 percent to 49 percent of the patients had a 50 percent or more reduction in the frequency of their seizures. Roughly 60 percent showed the same response to the therapy 24 to 48 months after implantation, and around 8 percent became completely seizure-free.

    Responsive Neurostimulation

    Responsive neurostimulation is like a pacemaker for your brain. It continuously monitors your brain waves, analyzes patterns so it can detect any activity that seems unusual or that may lead to a seizure, and quickly responds to that unusual activity with electrical stimulation to return your brainwaves back to normal before a seizure occurs. Each system is adjusted to your individual needs, placed within your skull, and connected to one or two electrodes that are placed on your brain.

    Like VNS therapy, responsive neurostimulation is for people whose seizures aren't controlled after trying at least two medications. It's FDA-approved for adults 18 years and older with focal epilepsy and, similar to VNS therapy, the effects seem to get better over time.

    Deep Brain Stimulation

    In deep brain stimulation (DBS), electrodes are placed in a specific part of your brain, often the thalamus. They are connected to a device that's implanted under the skin in your chest. The device is programmed to send electrical impulses to your brain to lessen or even stop your seizures. The FDA has approved this treatment for adults 18 years and older who have focal epilepsy that isn't controlled after trying three or more medications.

    Like VNS therapy and responsive neurostimulation, the effects also appear to increase with time. In one study, after one year of using DBS, 43 percent of patients reported a 50 percent or more decrease in seizures; after five years, 68 percent of patients reported the same decrease. Within five years after starting DBS, 16 percent of patients went for six months or more without any seizures. Quality of life reports also improved over time.

    Ketogenic Diet

    Like the therapies above, the ketogenic diet is often prescribed in cases where seizures aren't responding to two or more medications, particularly in children. This high-fat, low-carbohydrate diet is strict and can be difficult to follow, so it should be monitored by a dietician. It's especially helpful for certain epilepsy syndromes and makes it possible for some people to have their medication doses decreased.

    More than half of children who go on the ketogenic diet see a 50 percent reduction or more in their seizures. For adults, studies show that the ketogenic diet reduces seizures by 50 percent or more in 22 percent to 70 percent of patients, and by 90 percent or more in up to 52 percent of patients. A small percentage of both children and adults may eventually become seizure-free after several years on the diet under close supervision.

    Potential side effects include dehydration, stunted growth in children due to nutritional deficiencies, constipation, higher cholesterol in adults, and a buildup of uric acid in your blood, which can cause kidney stones. You will probably need to take vitamin and mineral supplements to make up for the diet's imbalances. This diet should always be implemented under medical supervision.

    Modified Atkins Diet

    The modified Atkins diet (MAD) is a less restrictive and newer version of the ketogenic diet that can be used for both adults and children. Like the ketogenic diet, the MAD needs to be implemented under medical supervision. While the foods are similar, fluids, proteins, and calories aren't restricted on the MAD. Food doesn't have to be weighed and measured, and there's more freedom when it comes to eating out or away from home. The MAD differs from the traditional Atkins diet in that fewer carbohydrates and more fat are encouraged.

    This diet seems to have similar results to the classic ketogenic diet. Studies show that seizures are reduced by 50 percent or more in 12 percent to 67 percent of adults, and up to 67 percent of adults have 90 percent or better seizure reduction. Potential side effects include weight loss, higher cholesterol in adults, and feeling ill, especially at first.

    Low Glycemic Index Treatment

    Another less restrictive version of the ketogenic diet, the low glycemic index treatment (LGIT) focuses more on carbohydrates that have a low glycemic index. It also doesn't restrict fluids or protein, and your food is based on portion sizes rather than weights. There haven't been many high-quality studies done on the effects of LGIT, but it seems to also be beneficial in reducing seizures.

    Home Remedies and Lifestyle

    There are some factors you can keep in mind and work on implementing into your life that may help your epilepsy.

    Get Enough Sleep

    Sleep deprivation can trigger seizures in some people, so make sure you're getting all the sleep you require every night. If you're having difficulty getting to sleep or you're waking up often, talk to your doctor and try these tips:

    • Limit your caffeine intake afternoon and don't have any after 5 p.m.
    • Turn off any device with blue light an hour before bed. This includes TVs, computers, tablets, phones, etc.
    • Work on creating a nightly bedtime ritual for yourself.
    • Give yourself at least an eight-hour window to sleep.
    • Make your room as dark as possible. Try covering any lights and using room-darkening shades or blinds.
    • Don't let the temperature in your bedroom get too warm. You'll sleep better if it's cooler.
    • Avoid alcohol before bed. It can affect how deeply you sleep.
    • Try not to nap during the day.
    • Wake up at the same time every morning.

    Manage Stress

    Too much stress is another potential trigger for seizures. If you're under too much stress, try delegating some responsibilities to others. Learn relaxation techniques such as deep breathing, meditation, and progressive muscle relaxation. Take time out for yourself to do activities you enjoy and find hobbies that help you relax and unwind.

    Exercise

    Besides helping you stay physically healthy, exercise can also help you sleep better, boost your mood, reduce anxiety, increase your self-esteem, relieve stress, and stave off depression. Since sleep deprivation and stress can be seizure triggers, incorporating exercise into your routine may help you sleep more deeply, fall asleep faster, stay asleep, and feel more relaxed. Make sure you don't exercise too close to bedtime, though, or you may end up having difficulty drifting off.

    Take Medications as Prescribed

    Be sure to take your medications exactly as your doctor prescribes so you can attain the best seizure control possible. Don't ever change your dose or stop taking your medication without consulting your doctor first. Depending on the type of epilepsy you have, staying on your medication consistently may eventually have your seizures under control for a long enough period that you can try going off of it with your doctor's supervision.

    Wear a Medical Alert Bracelet

    Wearing a medical alert bracelet that lists your medications is extremely important when you have epilepsy so that if you have an emergency, medical personnel know better how to help you. You can order one online or check with your local pharmacy.

    Complementary Medicine (CAM)

    There are some complementary alternative therapies that you may want to consider including with your regular treatments.

    Music

    Studies have been done on the relationship of music to seizures and it has been found that regularly listening to Mozart, particularly Mozart's Sonata for Two Pianos in D Major (K448), helps reduce seizures and EEG abnormalities in children. This is known as the Mozart Effect. No one knows what the relationship is between the music and the decrease in seizure activity, but you can try playing it before bed or throughout the day for your child and see if it makes any difference.

    There haven't been as many studies on how this works for adults, but it may also be beneficial. One study of both children and adults who listened to Mozart K448 for 10 minutes, three times a week for three months showed that, while both groups had fewer EEG abnormalities after that time, this effect was 25 percent more prevalent in the children. However, both groups had decreased seizures.

    Yoga

    A Cochrane review on yoga for epilepsy concluded that it may be beneficial in controlling seizures, but there isn't sufficient evidence to recommend it as a treatment for epilepsy. Because of this, yoga should only be used along with your regular treatments, never by itself. An additional benefit is that yoga can help you manage stress, a potential trigger for seizures.

    Biofeedback

    Also known as neurofeedback, biofeedback is a technique that allows you to measure your body's responses to seizure triggers (among other things). With time, you can use this information to help control automatic functions such as your heart rate and respiration, potentially reducing the frequency of seizures. Sensors attach to your body, so it's non-invasive, and it has no side effects.

    Multiple small studies have been done on biofeedback and the results show that it does help reduce seizures. This seems to be especially true with biofeedback using galvanic skin response (GSR), which measures the amount of sweat in your hands. Like many other epilepsy treatments, more studies need to be done.

    Blue-Tinted Lenses

    There is some evidence that wearing sunglasses with blue-tinted lenses may help people who have photosensitive epilepsy, but the research is limited and out of date. Blue-tinted lenses haven't been approved by the FDA for the treatment of seizures, but there's no harm in trying them out, as long as you keep using your regular treatments. The Zeiss Z-1 lenses mentioned in a popularly-cited 2004 study have to be purchased internationally, but you can get TheraSpecs fluorescent light glasses online. They're not blue-tinted, but they block blue-green light.

    The Future of Treatment

    There is a lot of work being done in the quest for less invasive and more effective treatments for epilepsy. Here's a rundown on some of the treatments that are being studied.

    Stereotactic Radiosurgery

    Stereotactic radiosurgery, or stereotactic laser ablation, may help patients who have focal seizures, don't respond well to medications, and aren't good candidates for conventional surgery. During the procedure, targeted radiation is used to destroy tissue in the part of the brain that's responsible for causing seizures. Preliminary evidence shows that it's effective for controlling seizures in mesial temporal lobe epilepsy, the most common type of focal epilepsy.

    Thermal Ablation

    Also known as laser interstitial thermal therapy or LITT procedure, a thermal ablation is an advanced form of stereotactic radiosurgery that uses magnetic resonance imaging (MRI) as a guide to the location to destroy tissue. It's much more precise and, like stereotactic radiosurgery, has fewer risks than traditional surgery. Studies have been limited and small, but MRI-guided LITT looks like a promising treatment with fewer side effects and better outcomes than other minimally invasive procedures.

    External Nerve Stimulation

    Though external trigeminal nerve stimulation is similar to vagus nerve stimulation in that it stimulates your nerves to reduce your seizures, the device is worn externally rather than implanted. One specific external trigeminal nerve stimulation device, the Monarch eTNS System, has been approved in Europe and Canada, though it's still being researched as a viable treatment option for epilepsy in the United States. Preliminary studies have been positive, showing both a reduction in seizure frequency and a boost in mood.

    Subthreshold Cortical Stimulation

    Like other stimulation therapies, subthreshold cortical stimulation uses electrodes connected to a generator. Instead of waiting until your brain starts exhibiting abnormal activity, this method provides continuous stimulation to the precise area of your brain in which seizures start, preventing them from the beginning. This treatment is still in the early stages of research, but the evidence so far indicates that it helps reduce seizures and improves quality of life.

    In one study done by neurologists at the Mayo Clinic, 10 out of 13 patients who received subthreshold cortical stimulation reported improvement in the severity of their epilepsy. Most of the patients also had at least a 50 percent reduction in the frequency of their seizures. This treatment could be especially helpful for people with focal epilepsy who aren't candidates for surgery.

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