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How is epilepsy (seizure disorder) treated?

Epilepsy can be treated both medically and surgically. Many drugs have been developed for treatment of epilepsy over the years. Usually the medication which has minimum side effects and maximum effectiveness is chosen by a neurologist. The clue to finding the right medication is the correct diagnosis of the type of epilepsy. The dose of the chosen medication may be adjusted until the seizures are well rare of absent.

Surgical treatment of epilepsy is reserved for patients with seizures resistant to medical treatment. This type of seizure disorder is called treatment resistant epilepsy. Epilepsy surgery includes a variety of resective and palliative procedures depending on the type of epilepsy syndrome. There are no age or gender restrictions. Both neurologists and neurosurgeons work as a team to achieve the goal of the best seizure control.

Medication to prevent epileptic seizures is the most common treatment approach for the disease. Medication controls seizures in half or more of patients for substantial periods of time, and significantly reduces the number of seizures in another 30 percent. Doctors can choose from a number of different anti-seizure medications depending on the patient's type of epilepsy. If epileptic seizures are not controlled after treatment with several different agents, doctors may consider medications available through clinical trials or surgical treatment. About a third of epilepsy patients do not respond to medications.

Neurosurgeons may use one of several surgical procedures to treat epilepsy. Most patients experience a great reduction in seizure frequency and severity after surgery. Patients with certain types of epilepsy have a greater than 70 percent chance of complete freedom from seizures following surgery.

Once epilepsy is diagnosed, treatment is designed to minimize the number and severity of seizures, which can severely impact brain function and have other negative effects. The first line of therapy is medication, which is prescribed based on the person’s history, gender, medicines they are taking and other factors.

If medication is ineffective, neurologists take a more in-depth look. Patients are sometimes admitted into a monitoring unit, where their brain activity is observed continuously for as long as a week. They are also videotaped, and the visual record is matched with the EEGs. Continuous monitoring can clarify the diagnosis, pinpoint the exact nature of the seizures and help determine treatments.

Monitoring can also help neurologists choose the most effective combination of medications. Sometimes, if medications are causing side effects and need to be changed rapidly, the monitoring unit is used to observe people during that process.

Another potential treatment is surgery. If doctors can pinpoint the exact site in the brain where the aberrant electrical activity is occurring, surgically removing that brain region can control seizures.

If the source of the brain’s electrical problems cannot be located, or there are multiple locations associated with seizures, brain surgery is not an option. A third choice is a device called a vagus nerve stimulator (VNS), which is attached to a nerve in the neck and sends signals to keep the brain’s electrical activity in check. In essence, it acts as a pacemaker for the brain.

Determining the underlying condition that is causing a person’s seizures and developing a treatment plan requires a comprehensive approach, which may include intensive monitoring. Ultimately, the goal of the neurologist is to use these various tools to personalize treatment.

Dr. Jerome Engel, MD
Neurologist

Approximately 60 percent of people with epilepsy have epileptic seizures that can be controlled by antiseizure (antiepileptic) drugs. There are many antiseizure drugs with different treatment effects and different side effects. Some drugs will treat almost all types of seizures while others are only effective for certain types of seizures or certain epilepsy syndromes. Other considerations are the side effects, dosing regimen and cost. For instance, drugs that might cause birth defects are usually not given to women of child-bearing age. Many people do not want to take drugs that might cause weight gain, irritability or depression. Fortunately, these side effects are relatively rare, and often disappear within days or a few weeks. Side effects of some antiseizure drugs may also be beneficial, so a patient who has epilepsy and migraine headaches may prefer an antiseizure drug that also treats migraine. Whether a drug needs to be taken once, twice or three times a day may also be an important consideration for some patients, and cost is a crucial factor for many. When two trials of appropriate antiseizure drugs have failed and seizures are disabling, patients should seek a consultation at a specialized epilepsy center. There are many reasons why drugs seem to fail, including the possibility that seizures are not epileptic, the wrong epilepsy diagnosis was made or the wrong drug was prescribed, the drugs aren't being taken properly or aren't being absorbed, lifestyle choices that promote seizure occurrence, or the drugs really don't work. When drugs really do not work, many patients may be eligible for surgical treatment, which has a high chance of curing epilepsy. Other alternative treatments include the ketogenic diet, vagus-nerve stimulation, hormonal therapy in women, behavioral therapy, and a number of new and still experimental therapies. Finally, many people with epilepsy, and their families, are compromised or disabled by the psychological and social consequences of epilepsy. These problems can be effectively addressed by specialized education, counseling and therapy.

Treatment options for seizure disorders, also known as epilepsy, include medication (in most cases), surgery (in some cases) and other less commonly used treatment strategies, such as implanted devices and dietary changes. About 80 percent of people with epilepsy are able to control their seizures with the kinds of treatment that are currently available. Most people with epilepsy are treated with antiepileptic drugs, and over 20 different kinds are available. Some people with epilepsy do not find sufficient relief with antiepileptic drugs. However, some types of epilepsy can be treated surgically if medication does not work. For example, in some cases a surgeon might be able to remove the small part of the brain that is affected by the seizures or might sever the connections between the malfunctioning brain nerve cells (neurons). Another option for some people with epilepsy is to have a device called a vagus nerve stimulator surgically implanted in the chest. This device delivers electrical impulses to the brain through a nerve in the neck. Some people with epilepsy, particularly children, have been found to benefit from a low-carbohydrate, high-fat diet.

Since seizures come in many variations, there is't a single pill or set dosage that can control them.

Patients may have to try many different drugs to find a combination that provides seizure control while preserving their quality of life. Many medications are considered to be disabling because they can affect cognitive processes, including thought and memory.

Dr. Jeanne Morrison, PhD
Family Practitioner

Treatment usually begins with the anticonvulsive medications. Many times, depending on the type of epilepsy, your doctor may prescribe more than one drug to control the seizures. Other treatment may include a diet such as the ketogenic diet. Surgery and vagal nerve stimulation may also provide treatment for some forms of epilepsy that cannot be controlled by medication.

 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.