There is at present no cure for epilepsy, although some people with epilepsy do go into remission — meaning all symptoms of the condition disappear. The good news is that while epilepsy is not yet curable, it is treatable for most people.
There is a wide range of epilepsy treatments, with most falling into one or more of four broad categories:
Before recommending a course of treatment, a physician will take into account your age, overall health, medical history, severity of condition, and type or types of seizure. The goal of epilepsy treatment is to stop seizures — or to at least decrease their frequency as much as possible.
Some epilepsies and seizure types are more difficult to treat because they are less responsive to most treatments.
In most cases, a medication will be the first treatment prescribed. On average, anti-epileptic drugs (AEDs) will work for 60 percent to 70 percent of people with epilepsy. However, in as many as 20 percent to 40 percent of epilepsy cases, seizures cannot be adequately controlled with any type of anticonvulsant medication. Drug-resistant epilepsy is also known as intractable or refractory epilepsy. In cases where AEDs are ineffective, doctors may recommend a special diet, an implanted device, or surgery.
AEDs work in different ways, but they are all believed to reduce excess electrical activity in the brain. There is an increasing number of AEDs on the market, and many of the newer medications offer more focused treatment with fewer serious side effects.
Most AEDs are taken by mouth — some are designed to dissolve in the mouth instead of being swallowed. Other treatments are given rectally or as an injection. AEDs that can be administered as a nasal spray are under development.
If you’ve been prescribed a medication that’s ineffective at controlling your seizures, or if its side effects are bothering you, contact your doctor. Finding the right medication and the right dosage can be a long process. In cases where AEDs are ineffective, the doctor may recommend diet changes or surgery.
Broad-spectrum AEDs can be effective for multiple seizure types. Broad-spectrum anticonvulsants include:
Apart from AEDs, other classes of drugs may be prescribed to control seizures. For instance, Klonopin (clonazepam) is a sedative of the benzodiazepine class used to treat Lennox-Gastaut syndrome, a severe form of epilepsy. Phenobarbital is a barbiturate, a class of drugs that depress the central nervous system.
All AEDs have side effects, especially during the first few weeks of treatment. Common side effects of AEDs include:
All AEDs are required by the U.S. Food and Drug Administration (FDA) to carry a suicide warning. The risk for suicide due to AEDs is quite low, but anyone taking an AED should be aware of and report any serious depression or suicidal thoughts to their doctor.
Some AEDs can interfere with hormonal birth control methods, and some birth control pills can interfere with the effectiveness of AEDs. Certain AEDs are also known to have a higher risk of birth defects if either birth parent is taking them.
Never change your dose or stop your medication without consulting with your doctor. Withdrawal must be done with close supervision. Suddenly stopping a medication can cause more severe seizures.
In cases where epilepsy is refractory (resistant to medication), doctors may recommend adopting a specific diet to help control seizures. Research shows that in combination with AEDs, a diet high in fat and low in carbohydrates can help some people control their epilepsy.
The ketogenic diet, used to treat children with refractory epilepsy, is an extreme diet involving fasting and monitoring by a physician and a nutritionist. The purpose of the diet is to force the body to burn fat for energy instead of carbohydrates, increasing the level of molecules called ketones in the blood. A ketogenic diet, in fact, acts the same way in the brain as AEDs. For some children, a high level of ketones reduces seizure activity.
For adults, a less extreme version of the ketogenic diet is the modified Atkins diet. One study found that the modified Atkins diet lowered seizure activity in nearly half of the adults who followed it for several months.
Diet changes should be made with your doctor’s knowledge and guidance.
Some people with intractable epilepsy may be candidates for an implanted device such as a vagus nerve stimulator (VNS), a responsive neurostimulation (RNS) system, or a neurostimulator for deep brain stimulation (DBS). A person’s eligibility for these devices varies by age. These devices are palliative options — meaning they are intended to provide symptom relief — for those who have tried several AEDs.
A vagus nerve stimulator is a device similar to a pacemaker that is implanted under the skin near the collarbone. The device uses a lead, or thin wire, to connect to the vagus nerve in the neck. It then stimulates the nerve at regular intervals, which can reduce the intensity and frequency of seizures. VNS may be more effective in treating focal seizures than other types of seizures.
A responsive neurostimulation system may also be used to treat epilepsy. This system is a small, electronic device that is implanted inside the skull. One or two thin wires from the device are connected to the seizure targets. The device is then programmed to detect and record brain activity patterns and respond with electrical stimulation when abnormal patterns are detected. Stimulation cannot be felt. Once you have this device implanted, you will receive a brain-activity monitor that will record data and send it to the neurologist.
People generally continue taking AEDs after receiving an implanted device.
Deep brain stimulation is a novel way of controlling seizures. It entails implanting an electrode in a specific area of the brain called the thalamus. The electrodes then deliver electrical impulses to regulate abnormal impulses or to affect certain brain cells and chemicals. This, in turn, can reduce the frequency of seizures. DBS is approved for use in people ages 18 and older with refractory epilepsy.
Surgical treatment may be recommended for people whose seizures are severe or frequent enough to be life-threatening or significantly impact quality of life. Candidates for epilepsy surgery must have failed several epilepsy drugs and have seizures with a known focus. Epilepsy surgeries fall into two general categories: resection and disconnection.
The most common type of neurosurgery for epilepsy is resection, in which the portion of the brain causing seizures is removed. If successful, the surgery can provide long-term remission from seizures. Names of resection procedures often end in “-ectomy,” which means “removal by cutting.”
Temporal lobectomy, also known as temporal lobe resection, is the most frequently performed of all epilepsy surgeries and has the highest rate of success. Other resection surgeries include:
Disconnection surgeries attempt to limit the spread of seizure activity and reduce seizure frequency. Disconnection surgeries are known as palliative treatments because they can improve quality of life, but they do not cure epilepsy.
The most common type of disconnection surgery is the corpus callosotomy, in which the fibers connecting the two hemispheres, or sides of the brain, are severed to prevent the spread of seizures from one side to the other. Corpus callosotomy surgery is usually performed on children who have debilitating seizures that cause injuries and falls. Multiple subpial transection is another surgery designed to disconnect the seizure focus, limiting the spread of seizures.
A functional hemispherectomy combines the resection of a seizure focus in one hemisphere with corpus callosotomy.
Some people with epilepsy try natural or alternative treatments. Some report improvements when they use medical cannabis, melatonin, or complementary therapies such as acupuncture, herbal or nutritional supplements, chiropractic treatments, and mind-body practices such as meditation.
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