Treatments for Epilepsy

Posted on August 01, 2018

There is at present no cure for epilepsy, although some people with epilepsy do go into remission. The good news is that while epilepsy is not yet curable, it is treatable for most people.

There are a wide range of epilepsy treatments, with most falling into one of four categories: medication, diet, implanted devices, and surgeries. Before recommending a course of treatment, a physician will take into account age, overall health, medical history, severity of condition, and type or types of seizure. The goal of epilepsy treatment is to stop seizures, or at least decrease their frequency as much as possible.

There is no one treatment that works for all types of seizures and types of epilepsy.

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 70 percent of people with epilepsy. In as many as 20 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.

Medication

AEDs work in different ways, but they are all believed to reduce excess electrical activity in the brain. There are an increasing number of AEDs on the market, and many of the newer medications offer more focused treatment with fewer side effects.

If a medication is ineffective at controlling 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.

Most AEDs are taken orally. Some may be given rectally, as an injection, or are designed to dissolve in the mouth rather than be swallowed. AEDs that can be administered as a nasal spray are under development.

Narrow-spectrum AEDs

Narrow-spectrum AEDs treat specific types of seizures, such as focal (partial) or absence seizures. Drugs in this category include Briviact (Brivaracetum), Dilantin (Phenytoin), Lyrica (Pregabalin), Neurontin, (Gabapentin), Phenobarbital, Trileptal (Oxcarbazepine), Vimpat (Lacosamide), and Carbamazepine, which is sold under the brand names Tegretol and Carbatrol.

Broad-spectrum AEDs

Broad spectrum AEDs can be effective for multiple seizure types. Broad-spectrum anticonvulsants include Depakote (Valproic acid), Keppra (Levetiracetum), Lamictal (Lamotrigine), Topamax (Topiramate), and Zonegran (Zonisamide).

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, and Phenobarbital is a barbiturate.

All AEDs have side effects, especially during the first few weeks of treatment. Common side effects of AEDs include drowsiness, dizziness, problems with memory or attention, vision changes, mood changes, and increase or decrease in appetite.

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 known to have a higher risk of birth defects if either the father or mother 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.

Diet

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. 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. The modified Atkins diet lowers seizure activity in nearly half of the adults who follow it for several months.

Diet changes should be made with your doctor’s knowledge and guidance.

Implanted devices

Some people with intractable epilepsy may be candidates for an implanted device such as a vagus nerve stimulator (VNS) or a responsive neurostimulation system (RNS). To be eligible, people must generally be 12 years or older and 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 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. When you go home, 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.

Surgery

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 extratemporal cortical resection, frontal lobectomy, lesionectomy, occipital lobectomy, parietal lobectomy, and right frontal lobectomy.

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 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.

Functional hemispherectomy combines the resection of a seizure focus in one hemisphere with corpus callosotomy.

Other treatments

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.

Resources

External resources

MyEpilepsyTeam resources

FAQs

Can I get assistance paying for my AEDs?

Anti-epileptic drugs can be costly. Many people with private or employer-sponsored health insurance are eligible for copay assistance programs – many with a $0 copay – through drug manufacturers. Some people without health insurance who meet low-income criteria may qualify for free AEDs through non-profit organizations or drug manufacturers.

What is the difference between brand-name and generic drugs?

Some medications are available as either brand-name or generic products. Generic drugs are almost always less expensive than brand-name drugs. Both products have the same active ingredient at the same dosage. However, some people with epilepsy notice differences between branded drugs and generics in the level of effectiveness, how quickly drugs become active, and how long they stay active between brand and generic medications. Side effects may also differ, or differ in intensity, between generic and brand-name AEDs. Generic versions may also differ between manufacturers. When switching to a generic, or if switching to a different manufacturer, inform your doctor about any breakthrough seizures or changes in side effects.

How can a service animal help someone with epilepsy?

Seizure response dogs are specially trained to support people with epilepsy when they have seizures. Seizure dogs can alert caregivers, activate an alarm system, retrieve a cell phone or medication, and act as a physical support by lying down next to a person having a seizure or helping them up. Rarely, after many years with a person, some service dogs can learn to recognize an oncoming seizure and warn the person before it happens.

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