How Is Epilepsy Treated?

Epilepsy is a neurological (brain) condition involving recurrent seizures. There are many types of epilepsy that vary depending on where the seizures occur in the brain, how severe the seizures are, and what symptoms occur before, during, and after a seizure. Antiepileptic drugs (AEDs) are usually the first treatment used across the different types of epilepsy. A neurologist (a doctor who specializes in conditions of the brain and spinal cord) may prescribe more than one drug to reduce the severity and number of seizures. 

If drug treatments aren’t helpful, there are alternative treatment methods available. However, these are rarely used unless absolutely necessary.

Treatment By Type of Epilepsy

Most cases of epilepsy are treatable with antiepileptic drugs prescribed by a neurologist. There are more than 25 drugs currently approved for treating epilepsy. Most require two daily doses, though there are exceptions for some of the drugs. Always follow your prescribing doctor’s instructions when taking medications. 

There are specific considerations that neurologists take into account when choosing an appropriate medication. Your age, sex, and seizure type may affect how well a drug works. Choosing the right medication can also help reduce potential side effects.

Often, treatment is successful and people with epilepsy are able to stop taking medication after a few years. More than 70% of children with common types of epilepsy eventually go off medication. More than two-thirds of adults are seizure-free after two years of treatment. They also then taper off their medication. 

When epilepsy causes focal seizures (seizures that occur in one area of the brain), surgeons can sometimes remove the part of the brain that is causing seizures. Surgery is also used to prevent epilepsy from spreading to the rest of the brain. Newer approaches use electrodes to stimulate the brain for people with generalized seizures (seizures that occur throughout the entire brain), such as a vagal nerve stimulator. This is like having a pacemaker that helps prevent seizures.

Treatment for Focal Onset Epilepsy

Focal onset epilepsy seizures may impact your senses, causing unexplainable feelings, repetitive movements, and a loss of consciousness. Fortunately, there are many different treatments for focal onset epilepsy. Treatments primarily include medications and surgery, and there's research being done to determine the effectiveness of the ketogenic (keto) diet.

Drug Treatments

While most medications are appropriate for general use, specific medications are recommended for special patient populations, including older adults and people who are pregnant or who are trying to get pregnant.

Medications that are generally considered include:

• Lamictal (lamotrigine)
• Keppra (levetiracetam)
• Trileptal (oxcarbazepine)
• Tegretol/Curatil (carbamazepine)
• Vimpat (lacosamide) 

For older adults:

• Lamictal (lamotrigine)
• Keppra (levetiracetam)
• Vimpat (lacosamide)

For people who may get pregnant:

• Lamictal (lamotrigine)
• Keppra (levetiracetam)
  

Surgery

Surgery may be available for people who don’t respond to drugs. Common procedures include the following:

• Lobectomy or lesionectomy: Removes the part of the brain causing seizures
• Multiple subpial transection (MST): Makes multiple cuts in the nerve fibers of the out layers of the brain to prevent seizures from spreading deeper
• Corpus callosotomy: Cuts the connecting fibers (the corpus callosum) between the left and right sides of the brain to prevent seizures from spreading
• Thermal ablation: Uses lasers to remove the parts of the brain causing seizures (this form of surgery is less invasive)
• Hemispherectomy: Removes one-half of the brain (this procedure is used as a last resort in children)
  

Ketogenic Diet

A ketogenic diet is high in fat and low in carbohydrates. Adhering to this strict diet may help children and adults with treatment-resistant epilepsy. However, the evidence for this diet’s efficacy for seizure treatment is still uncertain and further research is needed.

Side Effects

Common side effects across antiepileptic drugs include drowsiness, dizziness, and loss of balance. In rare cases, they may impair cognition and lead to a hypersensitivity reaction and changes in weight. Hypersensitivity is an exaggerated immune response occurring within 24 hours of taking the medication. Importantly, taking Depakene or Depakote (brand names of the drug valproate) while pregnant increases the chance of birth defects.

Surgery may provide relief when drugs don’t work, but there are potential side effects. Surgeons will use brain imaging techniques to determine where the seizures are occurring in the brain. But it is possible that the surgery may still cause damage to healthy regions of the brain. This can cause side effects, including cognitive impairment, personality changes, and physical disability.

Treatment for Generalized Epilepsy

Generalized epilepsy results in seizures that affect both sides of the brain. The type of seizure, as well as any underlying genetic factors, impact the choice of treatment. 

Generalized seizures may be tonic-clonic seizures, which involve muscle stiffening and twitching. It may also cause myoclonic seizures, which involve muscle twitching. In case of absence seizures, symptoms involve a temporary loss of consciousness.

The treatments for generalized epilepsy include drug treatments and brain stimulation. The ketogenic diet is also being investigated as a potentially effective complementary treatment.

Drug Treatments

Drug recommendations vary depending on the type of seizure that occurs:

For tonic-clonic seizures:

• Lamictal (lamotrigine)
• Keppra (levetiracetam)
• Depakene/Depakote (valproate)
• Topamax (topiramate)
• Zonegram (zonisamide) 

For myoclonic seizures:

• Keppra (levetiracetam)
• Depakene/Depakote (valproate)
• Zonegram (zonisamide) 

For absence seizures:

• Zarontin (ethosuximide)
• Depakene/Depakote (valproate)
• Lamictal (lamotrigine)
  

Brain Stimulation

With generalized epilepsy, there isn't one part of the brain that surgeons can remove to stop seizures. Instead, people who don’t respond to treatment may opt for brain stimulation devices. These devices are like pacemakers that electrically zap the brain to treat seizures. There are two approved types of brain stimulation treatments:

• Deep brain stimulation: Provides continuous stimulation to a part of the brain called the anterior nucleus of the thalamus.
• Responsive neurostimulation: Only provides stimulation to the brain when brain imaging suggests a seizure is about to occur.
  

Ketogenic Diet

A ketogenic diet is high in fat and low in carbohydrates. Adhering to this strict diet may help children and adults with treatment-resistant epilepsy. Further research is needed on using the ketogenic diet as a complementary treatment method. 

Side Effects

Like drugs for focal onset epilepsy, common side effects across antiepileptic drugs for generalized epilepsy include drowsiness, dizziness, and loss of balance. In rare cases, they may impair cognition, lead to hypersensitivity reactions, and changes in weight.

Deep brain stimulation may cause adverse effects, including:

• Burning or prickling sensation caused by the stimulation
• Pain at the implant site
• Bleeding near the implant site
• Headache
• Speech disorders
• Hemorrhage or infection 
• Lack of evidence to determine whether it can cause psychiatric side effects like depression or apathy

Living With and Managing Epilepsy

At least one-third of people with epilepsy experience issues with cognition, anxiety, or depression. Children experience stigma due to their seizures, leading to bullying, loneliness, or depression. Luckily, many of these concerns can be treated through therapy and counseling.

People who want to get pregnant may need to first get their symptoms under control. Tonic-clonic seizures are associated with increased risk for the pregnant person and fetus. The occurrence of other seizures is also associated with fetal injury.

Many states prevent people from driving unless they’ve been seizure-free for a certain period of time. Fortunately, many people treated for epilepsy enter remission, meaning they experience an extended time with few or no symptoms. They may go months or years without having a seizure. Just in case, it is suggested to wear a medical alert bracelet that provides important medical information in case of an emergency situation.

A Quick Review

Epilepsy is a neurological condition involving recurrent seizures. Thankfully, there are many treatment options for people with epilepsy. Usually, medications can reduce the frequency and intensity of seizures. In some cases, surgery or medical devices that provide brain stimulation may be needed. Many people can go years without seizures after successful treatment.