Although epilepsy has no cure, some people may go into remission when all seizure activity stops for a time. The encouraging news is that most people with epilepsy can manage their condition with treatment.

Epilepsy treatment options vary widely. Most fall into one or more of these categories:

• Medications to control seizures
• Diet
• Implanted devices
• Epilepsy surgery
• Natural and alternative treatments

When deciding on treatment, your doctor will consider age, overall health, medical history, how serious the condition is, and the type of seizures. This helps them choose a treatment plan that is as safe and effective as possible, with the goal of better seizure control and a better quality of life.

No single treatment works for all seizure types or types of epilepsy. Some epilepsies and seizure disorders, called drug-resistant or refractory epilepsy, can be harder to manage because they don’t respond well to standard treatments.

What Is the Most Common Treatment for Epilepsy?

Anti-seizure medications (ASMs) are the most common treatment for controlling seizures in people with epilepsy. Previously called antiepileptic drugs or anticonvulsants, these medications work very well and help about 70 percent of people with epilepsy control their seizures.

Anti-seizure medications work for about 70 percent of people with epilepsy.

However, in around 20 percent to 40 percent of epilepsy cases, seizures continue even with medication. This is called drug-resistant epilepsy, also known as intractable or refractory epilepsy.

When ASMs don’t work, doctors may recommend other treatments, such as a special diet, an implanted device, or surgery.

Below are five key categories of epilepsy treatment.

1. Anti-Seizure Medication for Epilepsy

ASMs work by reducing excess electrical activity in the brain. Seizures happen when groups of neurons, or brain cells, fire at the same time and create abnormal bursts of activity. ASMs help calm this overactivity, making it less likely for a seizure to start or spread.

Most ASMs are taken by mouth as a pill, but others are given rectally or as an injection. Nasal spray versions, such as diazepam (Valtoco) and midazolam (Nayzilam), are used to quickly stop or ease severe seizures or seizure clusters.

If your medications aren’t controlling your seizures well or cause side effects that bother you, talk with your doctor. Finding the right medication and dosage can take time. If ASMs aren’t effective, your doctor may suggest changing your diet or considering surgery.

Narrow-Spectrum ASMs

Narrow-spectrum ASMs treat specific types of seizures, such as absence seizures or focal seizures. Drugs in this category include:

• Brivaracetam (Briviact)
• Carbamazepine (Carbatrol, Tegretol)
• Ethosuximide (Zarontin)
• Gabapentin (Neurontin)
• Lacosamide (Vimpat)
• Oxcarbazepine (Trileptal)
• Phenytoin (Dilantin)
• Pregabalin (Lyrica)
• Stiripentol (Diacomit)
• Tiagabine (Gabitril)

Broad-Spectrum ASMs

Broad-spectrum ASMs can work well for multiple seizure types:

• Cannabidiol (Epidiolex)
• Cenobamate (Xcopri)
• Felbamate (Felbatol)
• Lamotrigine (Lamictal, Subvenite)
• Levetiracetam (Keppra, Roweepra, Spritam)
• Perampanel (Fycompa)
• Rufinamide (Banzel)
• Topiramate (Topamax)
• Valproic acid (Depakote)
• Zonisamide (Zonegran)

Doctors may also prescribe other classes of drugs to control seizures. For instance, clonazepam (Klonopin) and clobazam (Onfi, Sympazan) are sedatives in the benzodiazepine family. These drugs may be used to treat myoclonic seizures and Lennox-Gastaut syndrome, a severe form of epilepsy.

Another option is phenobarbital, which belongs to a class of drugs called barbiturates that slow down the central nervous system.

All ASMs can cause side effects, especially in the first few weeks. Common side effects include:

• Drowsiness
• Dizziness
• Appetite changes, weight loss, or upset stomach
• Mood changes
• Problems with memory or attention
• Vision changes

Some ASMs may cause drug interactions. This means that they may affect how other medicines work or be affected by them.

For example, ASMs can interfere with anticoagulants (blood thinners) like warfarin, birth control pills, cancer treatments, and medications that fight infections.

At the same time, birth control pills can make some ASMs less effective. Certain ASMs also raise the risk of birth defects if either birth parent is taking them.

To ensure your treatment plan is safe and effective, always tell your doctor about all medications, supplements, and herbal remedies you use.

Never adjust your ASM dosage or stop taking your medication without your doctor’s guidance. Quitting suddenly can lead to more frequent and severe seizures, including status epilepticus. This is a serious, life-threatening seizure that lasts too long or happens repeatedly without recovery in between.

Always work with your doctor when making any changes to your treatment.

2. Diet for Epilepsy

For drug-resistant epilepsy, doctors may recommend a specific diet to help control seizures. Research shows that combining ASMs with a high-fat, low-carbohydrate diet can help some people control their epilepsy.

For drug-resistant epilepsy, doctors may recommend a specific diet to help control seizures.

For example, the ketogenic (keto) diet is often used to treat children with refractory (hard-to-control) epilepsy. This diet is very low in carbohydrates and high in fat, so the body burns fat instead of sugar for energy. This process increases blood levels of molecules called ketones, which may help some children have fewer seizures.

Because the keto diet is very strict, a doctor and nutritionist need to monitor it carefully.

For adults, there’s a less strict version called the modified Atkins diet. This plan is mainly used for people who still have frequent seizures even while taking medication. Before making any big changes to your diet, talk with your doctor.

These dietary therapies need to be personalized to fit your health needs and should be checked regularly to make sure you’re getting the right nutrition and avoiding side effects.

3. Implanted Devices for Epilepsy

Some people with intractable epilepsy may be candidates for an implanted device such as a:

• Vagus nerve stimulation (VNS)
• Responsive neurostimulation system (RNS)
• Neurostimulator for deep brain stimulation (DBS)

Implantable devices are palliative treatments. This means they may not stop seizures completely, but they can still help reduce seizures and improve quality of life. These options are often considered for people who’ve tried several ASMs without success.

For people who have tried several ASMs without success, doctors may suggest an implantable device to help control seizures.

Vagus Nerve Stimulation

VNS is like using a pacemaker for the brain. The vagus nerve stimulator is placed under the skin, near the collarbone, with a wire that connects to the vagus nerve in the neck. The device sends regular signals to help calm seizure activity, especially focal seizures.

Newer models, such as AspireSR and SenTiva, can detect a fast heart rate that may signal an upcoming seizure and send extra stimulation to try to prevent it.

Responsive Neurostimulation System

An RNS is a small electronic device implanted in the skull. One or two wires are connected to places in the brain where seizures start. It watches for unusual brain activity and sends electrical pulses when it spots signs of a seizure, though you won’t feel the stimulation. It also records brain activity and sends updates to your neurologist.

Deep Brain Stimulation

DBS involves placing electrodes (thin wires for transmitting electrical signals) in an area of the brain called the thalamus. The electrodes send controlled electrical signals to help balance brain activity and reduce seizures.

DBS is approved for adults 18 and older who have drug-resistant epilepsy.

4. Epilepsy Surgery

Surgery may be an option when seizures are severe, happen often, or greatly affect quality of life. Epilepsy surgery is usually considered only after trying several medications without success and when seizures come from a specific part of the brain that can be targeted.

Epilepsy surgeries fall into two main categories: resection and disconnection.

Resection Surgery

Resection is the most common type of neurosurgery (brain surgery) for epilepsy. In this procedure, the area of the brain where seizures start is removed. If successful, the surgery can lead to long-term remission. Names of resection procedures often end in “-ectomy,” which means “removal by cutting.”

Temporal lobectomy, also called temporal lobe resection, is the most frequently performed epilepsy surgery and has the highest success rate. Other resection options are available depending on where seizures begin in the brain.

Disconnection Surgery

Disconnection surgeries are designed to interrupt seizure pathways rather than remove brain tissue. They’re considered palliative treatments because they can improve quality of life, but they don’t cure epilepsy.

The most common type of disconnection surgery is a corpus callosotomy. This procedure cuts the corpus callosum, a bundle of nerves that connects the two sides of the brain. This surgery can help keep seizures from spreading to both sides of the brain.

A corpus callosotomy is usually performed on children who have dangerous drop seizures that cause injuries and falls.

Another option, multiple subpial transection, disconnects the brain area causing seizures and may be used when removing brain tissue isn’t safe.

A functional hemispherectomy is more extensive, typically reserved for very severe cases. This procedure involves disconnecting a large part of one side of the brain, often combined with a corpus callosotomy, to stop seizures from spreading.

Learn more about evaluating your options for epilepsy surgery.

5. Natural and Alternative Treatments for Epilepsy

If you’re interested in natural or alternative treatments for epilepsy, be sure to talk with your doctor first. They can help you understand the possible benefits and risks of these options and whether they could interfere with your ASMs. Keep in mind that natural doesn’t necessarily mean safer or more effective.

Some people with epilepsy report improvements with complementary therapies such as:

• Acupuncture
• Herbal or nutritional supplements
• Chiropractic care
• Meditation

Some people have found relief using medical cannabis (marijuana). Epidiolex is the first cannabidiol (CBD) medication approved by the U.S. Food and Drug Administration (FDA) to treat certain epilepsy syndromes, including Lennox-Gastaut syndrome and Dravet syndrome.

Early research suggests that melatonin might help reduce seizure severity when used with other treatments. However, more studies are needed.

Tips for Managing Epilepsy

Along with following your treatment plan, these habits may help you manage epilepsy:

• Get enough sleep.
• Try to lower stress.
• Drink plenty of water.
• Protect yourself from colds and other contagious illnesses.
• Avoid alcohol.
• Avoid recreational drugs.
• Take your medicine as prescribed.
• Do not skip meals.

Be sure to consult your doctor before taking new medications, as some can make seizures worse. By following your treatment plan and working closely with your healthcare team, you may be able to lower your risk of seizures and support your overall health.

Join the Conversation

On MyEpilepsyTeam, people share their experiences with epilepsy, get advice, and find support from others who understand.

Have you tried any of these epilepsy treatment options? Do you have advice for people living with epilepsy? Let others know in the comments below.