Epilepsy: Treatment Overview

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Treatment Overview

Treatment can reduce or prevent seizures in most people who have epilepsy, which can improve the quality of your life. Controlling your epilepsy also lowers the risk of falling and other complications that can happen when you have a seizure.

First your doctor will determine what type of epilepsy and what kinds of seizures you have. Treatment that controls one kind of seizure may have no effect on other kinds. Your doctor will also consider your age, health, and lifestyle when planning your treatment.

It may take time for you and your doctor to find the right combination, schedule, and dosage of medicines to manage your epilepsy. The goal is to prevent seizures while causing as few unwanted side effects as possible. With the help of your doctor, you can weigh the benefits of a particular treatment against its drawbacks, including side effects, health risks, and cost.

After you and your doctor figure out the most effective treatment for you, it is important that you follow your treatment exactly as prescribed.

Initial treatment

Initial treatment for epilepsy depends on the severity, frequency, and type of seizures and whether a cause for your condition has been identified. Medicine is the first and most common approach. Antiepileptic medicines do not cure epilepsy, but they help prevent seizures in well over half of the people who take them.¹

Medicines that may be used first to treat epileptic seizures include:

• Carbamazepine (Tegretol, Carbatrol).
• Ethosuximide (Zarontin), for absence seizures only.
• Topiramate (Topamax).
• Oxcarbazepine (Trileptal).
• Phenytoin (Dilantin, Phenytek) or fosphenytoin (Cerebyx).
• Valproic acid or divalproex sodium (Depakene, Depakote).
• Phenobarbital (Luminal Sodium, Solfoton). Phenobarbital is a first-line medicine for newborns.
• Primidone (Mysoline). The body converts primidone into phenobarbital.

See information on:

Epilepsy: Taking your medicines properly.

Other types of treatment may be used along with medicines to better control seizures, such as:

• Ketogenic diet, which is a high-fat diet that has been used with some success to treat people, especially children, who have severe, uncontrolled seizures. Some doctors may not support its use.
• Vagus nerve stimulation. The stimulator device is used with medicine or surgery to reduce seizures.

It is not always clear whether to begin treatment after a first seizure. It is difficult to predict whether you will have additional seizures. Antiepileptic medicines are not usually prescribed unless you have risk factors for having another seizure, such as brain injury, abnormal test results, or a family history of epilepsy.

Ongoing treatment

If epileptic seizures continue even though you are being treated, additional or other antiepileptic medicines may be tried, including:

• Felbamate (Felbatol).
• Gabapentin (Neurontin).
• Lamotrigine (Lamictal).
• Levetiracetam (Keppra).
• Tiagabine (Gabitril).
• Topiramate (Topamax).
• Zonisamide (Zonegran).
• Benzodiazepines (for example, Diastat, Tranxene, Valium).
• Phenobarbital (Luminal Sodium, Solfoton). Phenobarbital is a first-line medicine for newborns.
• Primidone (Mysoline). The body converts primidone into phenobarbital.
• Pregabalin (Lyrica). This medicine is intended to be used along with other antiseizure medicine.

See information on:

Epilepsy: Taking your medicines properly.

In addition to medicines, other treatments may be added to help reduce the frequency and severity of epileptic seizures, including:

• Ketogenic diet, which is a high-fat diet that has been used with some success to treat people, especially children, who have severe, uncontrolled seizures. Some doctors may not support its use.
• Vagus nerve stimulation. The stimulator device is used with medicine or surgery to reduce seizures.
• Brain surgery. Some people with epileptic seizures do not respond to medicine but have great success with surgery.
  • Anterior temporal lobectomy is the most common brain surgery for epilepsy in adults. It involves removing part of one of the brain's temporal lobes to reduce seizures.
  • Hemispherectomy is a common surgery for severe epilepsy in children. This technique involves removing the damaged side of the brain.
  • Corpus callosotomy is another common surgery for epilepsy in children. This technique involves surgically disconnecting the two sides (hemispheres) of the brain to prevent generalized seizures. It does not help with partial seizures.

Surgery is not used just as a last resort to treat epilepsy. Although brain surgery may sound frightening, it can successfully reduce seizures that are harmful, severe, frequent, or do not respond to medicines. Surgery can greatly improve the lives of some carefully screened people with epilepsy and can be a better choice than trying numerous medicines. If you would like to know if surgery is a good choice for you, talk with your doctor.

Treatment if the condition gets worse

If you have epilepsy with seizures that have not been controlled with medicines or other treatments, you may want to consider having surgery to reduce the frequency and severity of the seizures. While brain surgery may sound frightening, it can be effective in reducing epileptic seizures and can greatly improve the quality of your life. Surgery for epilepsy may involve removing an area of abnormal tissue in the brain (such as a tumor or scar tissue) or the specific area of brain tissue where seizures begin.

• Anterior temporal lobectomy is the most common brain surgery for epilepsy in adults. It is the removal of part of one of the brain's temporal lobes to reduce seizures.
• Hemispherectomy is a commonly used surgical technique in children with severe epilepsy. In this procedure, the damaged side of the brain is removed.
• Corpus callosotomy, another common surgery, disconnects the two sides (hemispheres) of the brain to prevent generalized seizures in children. This surgery does not help with partial seizures.

Treating prolonged seizures. Status epilepticus is a prolonged seizure or cluster of seizures that requires emergency treatment. It can happen in people who don't have a history of epilepsy and in those who do.

A seizure or cluster of seizures that goes on for more than 20 to 30 minutes during which you or the person seizing does not wake up may cause brain damage. Emergency treatment should be started as soon as possible in these cases.

Medicine used to stop the seizure is given in a vein (intravenously, or IV) so that it takes effect more quickly. If IV medicine is not available, medicine may be given rectally or as a shot in the muscle.

Vital signs, such as blood pressure and pulse rate, will be checked. A physical exam and various lab tests are done to rule out or identify any life-threatening medical conditions (such as meningitis, stroke, or failure of the heart, liver, or kidneys) that may have caused the prolonged seizure.

What To Think About

Early treatment may reduce the risk of progressing to more frequent and severe seizures.

You are more likely to have additional seizures if you have had two or more seizures. Doctors usually recommend treatment in these cases.³

Misdiagnosis and inappropriate treatment can lead to unnecessary medicine side effects and medical expenses, and a loss of work or driving privileges. It can also make the time until you get treatment for the actual condition longer.

Last updated:	October 29, 2007
Author:	Monica Rhodes
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Steven C. Schachter, MD - Neurology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC