When the doctor has made a diagnosis of seizures or epilepsy, the next step is to select the best form of treatment. If the seizure was caused by an underlying correctable brain condition, surgery may stop seizures. If epilepsy — that is, a continuing tendency to have seizures — is diagnosed, the doctor will usually prescribe regular use of seizure-preventing medications. If drugs are not successful, other methods may be tried, including surgery, a special diet, complementary therapy or vagus nerve stimulation (VNS). The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for people to lead active lives.
Most epilepsy medicines are taken by mouth. The doctor’s choice of which drug to prescribe depends on what kind of seizure a person is having. Some people experience side effects, others may not. Some people’s seizures will respond well to a particular drug while someone else will have seizures that continue. It may take some time to find exactly the right dose of the right drug.
There is no cure for epilepsy, yet. Medications do not cure epilepsy in the same sense that penicillin can cure an infection. For many people with epilepsy, however, the medication will prevent seizures as long as they are taken regularly; but, successful drug therapy requires the active cooperation of the patient.
Antiepileptic drugs successfully prevent seizures in the majority of people who take them regularly and as prescribed. It has been estimated that at least fifty percent of all patients with epilepsy gain complete control of their seizures for substantial periods of time. Another twenty percent enjoy a significant reduction in the number of seizures. If patients, in collaboration with their physicians, decide to attempt withdrawal from medications, they should be aware that the seizures may recur and should closely observe seizure precautions. Some individuals, however, have an excellent chance of remaining seizure free without medication in the future.
Unfortunately, some people continue to have seizures regularly despite taking medication. For them, surgical or, in children, dietary therapy with the ketogenic diet may be helpful. There is also hope that continuing research will produce new drugs and new ways of using them that will eventually give seizure relief to everyone who has epilepsy. The Epilepsy Foundation continues to fund basic and clinical research in the field of epilepsy and seizure disorders, and is looking forward to the time when a cure for these conditions will be achieved.
Finding the Right Medicine
When selecting a drug, your doctor will consider the type of seizures you have. Not all medications work for all types of seizures.
Factors Influencing Drug Selection
Different seizure types and different types of epilepsy have different natural histories (i.e., how the disorder develops over time). These unique features may dictate when to treat and for how long.
About Side Effects
Parents and individuals on medications need to be aware of side effects they experience, and report any changes in health, behavior, or mood to their physicians.
Importance of Compliance
Compliance is particularly important in epilepsy treatment because of the risk of seizures if the level of medication in the blood falls too low.
Effectiveness of Treatment
Antiepileptic drugs provide complete control for more than half of all patients with epilepsy, and reduce the number of seizures in another 20 to 30 percent.
Sudden unexpected seizures in someone who previously had achieved reliable control may result from a number of factors.
Discontinuing Antiepileptic Drugs
Antiepileptic drugs may not have to be taken for a lifetime. When seizures have been reliably controlled over a period of time (usually a year or two), there is a good chance that a timed, careful withdrawal from the medication will be successful.
Surgical removal of seizure-producing areas of the brain has been an accepted form of treatment for over 50 years when medicines fail to prevent seizures. However, because of new surgical techniques and new ways of identifying areas to be removed, more of these operations are being done now than ever before, and with greater success.
Vagus Nerve Stimulation
Vagus nerve stimulation is a type of treatment in which short bursts of electrical energy are directed into the brain via the vagus nerve, a large nerve in the neck. The energy comes from a battery, about the size of a silver dollar, which is surgically implanted under the skin, usually on the chest. Just how it works to prevent seizures is being studied.
Responsive neurostimulation is a new approach to treating medically uncontrolled partial onset seizures. The RNS® System is the first device to provide responsive neurostimulation, automatically monitoring brain signals and providing stimulation to abnormal electrical brain events just when it is needed. The system is approved by FDA as an adjunctive treatment for adults with medically refractory partial seizures that come from one or two seizure targets identified by your doctor.
The ketogenic diet, which is very high in fats and low in carbohydrates, makes the body burn fat for energy instead of glucose. When carefully monitored by a medical team familiar with its use, the diet helps two out of three children who are tried on it and may prevent seizures completely in one out of three.