The goal in epilepsy treatment is to reduce or eliminate the frequency of seizures. The current standard treatment mostly revolves around medications. Treatments will either be short-term or long-term, depending on the type of epilepsy you have.
Your doctor may include other forms of treatment, including dietary changes, exercise, and other healthy lifestyle choices. They may ask that you curb any unhealthy choices and behaviors that can interfere with treatment.
Surgery is an option, but it’s only used in severe cases when medication is ineffective.
Most epilepsy is treatable with medication. There are a number of drugs available. Some are useful for easing a variety of seizures, while others work best on specific types. Certain medications are used to complement primary seizure treatments.
There are numerous side effects that come with drug treatment. The kind of side effects a person might encounter depends on the drug or drugs being used to treat their epilepsy.
Some common side effects of epilepsy medications include:
- vision problems
- coordination difficulties
- speech problems
- upset stomach
- mild skin rash
The two main classifications of antiepileptic drugs (AEDs) are narrow-spectrum AEDs and broad-spectrum AEDs. Narrow-spectrum AEDs work on specific types of seizures, while broad-spectrum AEDs work on multiple types of seizures and other conditions.
- Carbamazepine (Tegretol): This drug tends to be more effective with partial and tonic-clonic seizures. Side effects include fatigue, double vision, loss of coordination, and possibly an effect on the body’s calcium and vitamin D metabolism. It can also, in rare cases, cause a decrease in infection-fighting cells in the blood.
- Ethosuximide (Zarontin): This drug only works against absence seizures. Side effects include drowsiness and fatigue, headaches, hiccups, and nausea. It can also cause rash and suppression of blood cell production in the bone marrow (leukopenia or pancytopenia).
- Gabapentin (Neurontin): This drug can be effective against partial and secondary generalized seizures. Side effects are usually few and mild with Gabapentin. They include sleepiness and fatigue, dizziness, and lack of coordination.
- Phenobarbital (Luminal): This is one of the first drugs that was found to be effective in fighting seizures and it is still occasionally used. It’s effective against many types of seizures. The drawbacks of this drug include fatigue, rash, drowsiness, blurred vision, dizziness, and lack of coordination. Other side effects include behavioral changes and loss of focus and concentration. Long-term use can also increase the risk of osteoporosis and anemia.
- Phenytoin (Dilantin): This is another older epilepsy drug. Unlike phenobarbital, Phenytoin tends to be more effective with partial and tonic-clonic seizures than with other types. Side effects can include dizziness, loss of coordination, slurred speech, tremors, loss of concentration, and jerking of the eyes. Some of the more pronounced side effects include facial hair growth in women, increased growth of the gums, and acne.
- Tiagabine Hydrochloride (Gabitril): This drug is effective against partial seizures. It can cause dizziness, headaches, sleepiness, and tremors.
- Clonazepam (Klonopin): This drug is effective against a wide spectrum of seizure types. The major problem with this drug is tolerance. The body can get used to the medication, causing it to stop working. It can also cause sleepiness, a loss of coordination, swelling in the legs, memory problems, and in some cases an increase in seizures.
- Felbamate (Felbatol): This drug fights a wide range of seizures. Serious side effects, such as failure of the liver or bone marrow, have been associated with this drug.
- Lamotrigine (Lamictal): This is a newer drug that is effective against most seizures. This drug can cause a serious rash, headache, dizziness, clumsy movements, and double vision.
- Primidone (Mysoline): This is another longtime anticonvulsant that’s effective against a wide range of seizures. This drug has side effects similar to those of phenobarbital and is used less often than other treatments.
- Topiramate (Topamax): This can be used in conjunction with other drugs and is effective against a range of seizure types. It can cause weight loss and problems with memory and focus. In some cases, people using this drug develop kidney stones.
- Valproate Sodium or Valproic Acid (Depakote): This drug is effective against most seizure types. Stomach problems, weight gain, tremors, nausea, and hair loss are all side effects that can occur with this drug. It can also cause problems with the pancreas and the liver.
Drugs are ineffective in some cases. Surgery may be an option if the part of the brain where the seizures originate doesn’t affect vital functions like your speech, language, and hearing abilities. For areas of the brain that cannot be removed, there are different surgical procedures that can prevent seizures from spreading to other parts of the brain.
There are several types of surgery that might be used in the case of refractory seizures. They include the following.
- temporal lobectomy: This surgery removes the portion of the brain’s temporal lobe that is causing the seizures.
- hemispherectomy: This surgery involves deactivating one of the brain’s hemispheres by removing the affected portions of the cerebral hemisphere. This procedure is usually considered for children suffering from Rasmussen’s encephalitis epilepsy, which can heavily damage a hemisphere of the brain.
- corpus callosotomy: The brain’s primary division is into two hemispheres. These two hemispheres use a specialized connective tissue called the corpus callosum to communicate. This procedure partially or completely separates the corpus callosum, minimizing or preventing communication between the hemispheres.
- vagus nerve stimulation (VNS): This surgery involves the insertion of a small machine into the patient’s body. Wires are run from it to the vagus nerve. The machine periodically causes the nerve to stimulate the brain. This can suppress seizures.
If you encounter someone who is having a seizure, the Centers for Disease Control and Prevention (CDC) offers these tips for emergency treatment and first aid:
- Keep calm and reassure other people who may be nearby.
- Prevent injury by clearing the area around the person of anything hard or sharp. Ease the person to the floor and put something soft and flat, like a folded jacket, under his or her head.
- Remove eyeglasses and loosen ties or anything around the neck that may make breathing difficult.
- Begin to time the seizure with your watch.
- Call 911. Don’t hold the person down or try to stop his or her movements.
- Contrary to popular belief, it’s not true that a person having a seizure can swallow his tongue. Do not put anything in the person’s mouth. Efforts to hold the tongue down can injure the teeth or jaw.
- Turn the person gently onto one side. This will help keep the airway clear.
- Don't attempt artificial respiration except in the unlikely event that the person does not start breathing again after the seizure has stopped.
- Stay with the person until the seizure ends naturally and they are fully awake.
- Do not offer the person water or food until fully alert.
- Be friendly and reassuring as consciousness returns.
- Offer to call a taxi, friend, or relative to help the person get home if they seem confused or unable to get home without help.
Here are a few things you can do to help someone who is having a seizure that involves blank staring, loss of awareness, or involuntary blinking, chewing, or other facial movements:
- Stay calm and speak reassuringly.
- Guide them away from dangers.
- Block access to hazards, but don’t restrain the person.
- If the person is agitated, stay a distance away, but close enough to protect them until full awareness has returned.
Consider a seizure an emergency and call 911.