If you have been diagnosed with epilepsy, you will have many questions. One of the first will probably be, "How can my epilepsy be treated?" There is no single answer to this question. That is because doctors have identified hundreds of different epilepsy syndromes, which involve many different types of seizures.
Your epilepsy may be inherited, or it may not. One study has found that some people with epilepsy have inherited an abnormally active version of a gene that makes them resistant to drugs. This may explain why some people have a hard time controlling their seizures with medication.
Even though they may look very different, seizures all start in the same place: your brain. They are caused by sudden changes in the way brain cells send electrical signals back and forth. But just because they start in the same place does not mean they can be treated in the same way. Your doctor will want to obtain an accurate diagnosis of the exact type of epilepsy that you have. Only then can your doctor create the treatment plan that is right for you.
Today, most epilepsy is treated with medication. Drugs do not cure epilepsy, but they can often control seizures very well. About 80% of people with epilepsy today have their seizures controlled by medication at least some of the time. Of course, that means that 20% of people with epilepsy are not helped by medication. And others who do take medication say that it doesn't help enough. Your doctor will work with you to select the right kind of medication for your type of seizures. If you find that the medication does not control your seizures, your doctor can then talk with you about other treatment options.
There are more drugs available today to control seizures than ever before. In fact, there are more than 20 different medications now on the market to treat epilepsy. They include:
- Carbamazepine (Tegretol or Carbatrol)
- Divalproex (depakote, Depakote ER)
- Diazepam (Valium and similar tranquilizers)
- Diazepam nasal spray (Valtoco, Neurelis)
- Ethosuximide (Zarontin)
- Phenytoin (Dilantin or Phenytek)
- Phenobarbital
- Primidone (Mysoline)
- Valproic acid (Depakene)
Newer drugs used to treat epilepsy include:
- Brivaracetam (Briviact)
- Cannabidiol (Epidiolex)
- Cenobamate (Xcopri)
- Clobazam (Onfi, Sympazan)
- Eslicarbazepine acetate (Aptiom)
- Felbamate (Felbatol)
- Fenfluramine (Fintepla)
- Gabapentin (Neurontin)
- Lacosamide (Vimpat)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Oxcarbazepine (Oxtellar XR)
- Perampanel (Fycompa)
- Pregabalin (Lyrica)
- Rufinamide (Banzel)
- Stiripentol (Diacomit)
- Tiagabine (Gabitril)
- Topiramate (Topamax)
- Vigabatrin (Sabril)
- Zonisamide (Zonegran)
emergency situations. Referred to as “rescue medications,” these drugs do not take the place of daily medications. Depending on the circumstance, they can be administered:
- Nasally - Sprayed up the nose
- Orally - Swallowed in pill form
- Sublingually - Placed under the tongue to dissolve
- Buccally - Placed between the cheek and the gum to dissolve
- Rectally - Given via a gel through the anus
The most commonly used medications are benzodiazepines because they get into the bloodstream quickly to start working on the brain to stop the seizure. They include:
For more information about each drug, see Each of these drugs is slightly different. Some work well for some kinds of epilepsy and not for others. Each one also has its own side effects, like all drugs do. Besides your type of epilepsy, here are some other factors that can influence which drug might be right for you. You should discuss these with your doctor:
- Your age, gender, and other health issues
- How the drugs work and possible side effects
- Other drugs you are taking
- What kind of side effects you can live with
- What you hope that the medication will do for you; for example, you might want a medication that makes you more alert and better able to concentrate at work.
There are also specific questions that women with epilepsy should ask. For example:
- Is it safe to get pregnant while taking this drug?
- Could this drug interfere with my birth control?
- My seizures seem to be affected by my menstrual cycle. Will this drug help manage that?
- Could this drug increase my risk for osteoporosis?
One thing to keep in mind: Osteoporosis is a weakening of the bone structure that can occur as you get older. Some anti-seizure drugs for epilepsy can increase the risk of developing osteoporosis if you take them for a long time. Because osteoporosis affects women far more than men, it is particularly important that you discuss this with your doctor when you plan your epilepsy treatment. You can then work together on ways to help protect your bone health. This would include eating a diet high in calcium, taking calcium and vitamin D supplements, getting lots of exercise, and avoiding alcohol and cigarettes.
Since all people are different, what works for one person with the same kind of seizures you have may not work for you. You may find the right medicine right away, or you and your doctor may have to try two or more to find the one that is effective for you. When you first start taking a new drug, it's a good idea to keep track of any side effects you experience and tell your doctor about them. You may not be sure whether a symptom you experience -- like depression or weight gain -- is caused by the medication. If you're not sure, it's safest to tell your doctor about it, anyway. Then you can both discuss the severity of the side effects and what to do about them.
Many people find that their epilepsy is controlled by just one medication. This is called monotherapy. Monotherapy has less risk of side effects than if you take more than one medication. It is also safer if you are planning to become pregnant. In some cases, though, one drug alone cannot control seizures. If this is true in your case, your doctor may want to try two or more drugs in combination -- polytherapy. Usually, you will start only one new medication at a time. This helps your doctor keep track of how well each one works, and whether there are any side effects.
What if medication cannot control your epilepsy? Discuss with your doctor a seizure action plan that contains rescue meds. Doctors are learning more about treatment options that may help people with hard-to-control epilepsy. These include:
Ketogenic diet. It's a strict meal plan that may help children whose seizures aren't controlled by medicine. You'll need to work closely with your doctor and a dietitian. The diet usually starts out with a fast that lasts 24 to 48 hours. Your child will likely need to be in the hospital while this happens so doctors can monitor their health. After that, they'll need to stick to foods that are high in fat and, at first, give up carbs. About two-thirds of kids who follow it are able to stop their seizures or at least see improvement in their epilepsy. There are side effects that you need to watch out for. Your child could get dehydrated, constipated, or develop kidney stones or gallstones.
Surgery. Doctors have performed surgery for years to help patients with epilepsy. New surgical techniques have improved the outcomes. Depending on the type of seizure you have, if you have tried several medications without success, your doctor may recommend surgery.
Vagus nerve stimulation (VNS). A vagus nerve stimulator works a lot like a pacemaker. It is surgically implanted in the chest, and delivers short bursts of energy to the brain. Scientists have found that it reduces seizures by about 40% to 50%. It does not work for everyone. If your doctor recommends VNS, you will probably still need to take medication, but you may be able to reduce your dose.
Responsive neurostimulation device (RNS). RNS has "Breakthrough Device" status for idiopathic generalized epilepsy. This treatment option consists of a small neurostimulator implanted under the scalp and within the skull. The neurostimulator is connected to one or two wires (called electrodes) that are placed where the seizures are suspected to originate within the brain or on the surface of the brain. The device detects abnormal electrical activity in the area and delivers electrical stimulation to normalize brain activity before seizure symptoms begin.
If you continue to have seizures while taking medication, there are several questions you can ask your doctor:
- Are there any new drugs for epilepsy that might work for me?
- Should I go to a special center for more testing?
- Do I have the kind of epilepsy that might be treated by surgery?
- Would my seizures respond to VNS therapy?
Having epilepsy can make it feel like you are not in complete control of your life. You can do your best to take back control by following these three steps: Work in partnership with your doctor. Keep track of information, such as when you have the seizures and the side effects of your medications. Ask questions. There are many resources available to help you manage your epilepsy and live a happy, healthy, productive life.
