How Epilepsy Is Treated

Epilepsy is usually treated with prescription drugs to control seizures, but it may also involve surgery, nerve stimulation devices, or special diets, depending on your situation and how well your seizures are controlled with medication. Multiple new epilepsy treatments are on the horizon, as well.

Regardless of the treatment course you follow, the end goals are the same: to allow you to live your fullest life, prevent seizures, and minimize the effects of managing your disorder. Finding the right path for you can take some time.

Prescriptions

Once you’re diagnosed with epilepsy, your healthcare provider’s first act will likely be prescribing anti-seizure medication (antiepileptic drugs) to control your seizures. Most people’s seizures can be controlled with just one medication, but some people may need more.

The kind and dosage your healthcare provider prescribes for you will depend on many factors, such as your age, the type and frequency of your seizures, and other medications you’re taking. It can take some trial and error to find the best drug and dosage with the fewest side effects for you.

With some medications, missing a dose isn’t a problem. However, missing even a single dose of your anti-seizure medication may cause you to lose control of your seizures. It’s extremely important to take your medication exactly as prescribed and talk to your healthcare provider if you’re having any difficulties with it.

Many people are able to control their seizures with antiepileptic drugs and, after a few years without any seizures, can eventually stop taking them. Stopping your anti-seizure medication too early or on your own can create serious problems, so be sure to work with your healthcare provider on deciding if and when to stop treatment.

There are more than 20 different types of antiepileptic drugs available, including:

• Tegretol, Carbatrol (carbamazepine): Used for children and adults, carbamazepine is also used to treat pain in conditions like neuropathy and trigeminal neuralgia. Common side effects include dizziness, abnormal thinking, trouble speaking, tremor, constipation, and dry mouth.
• Onfi (clobazam): This sedative is usually used along with other medications to treat children and adults with Lennox-Gastaut syndrome or other severe forms of epilepsy. Common side effects include fatigue, drooling, constipation, fever, aggressive behavior, difficulty sleeping, and slurred speech.
• Keppra (levetiracetam): This is one of the more commonly used antiepileptic drugs to treat adults and children. It can be used alone or with other medications. Common side effects include sleepiness, infection, weakness, dizziness, tiredness, decreased appetite, irritability, aggressive behavior, and nasal congestion.
• Dilantin (phenytoin): One of the oldest anticonvulsants, phenytoin can be used alone or with other medications for both adults and children. Common side effects are drowsiness, abnormal eye movements, coordination problems, slurred speech, confusion, and problems with movement and balance.
• Depakote (valproic acid): Used alone or with other medications. For children and adults, valproic acid treats absence seizures, generalized tonic-clonic seizures, and myoclonic seizures. Common side effects include headache, loss of appetite, sleepiness, weakness, tremors, blurry or double vision, coordination problems, swelling in your arms or legs, gastrointestinal problems, and hair loss.
• Neurontin (gabapentin): Gabapentin is used to prevent seizures, treat restless legs syndrome, and ease neuropathic pain. Common side effects include drowsiness, double vision, coordination problems, difficulty speaking, swelling in your legs or feet, and tremors.
• Phenobarbital: As one of the oldest anticonvulsants, phenobarbital is a barbiturate that’s also one of the best-understood and researched medications. It’s used alone or with other medications in adults and children. Common side effects include drowsiness, headache, dizziness, increased activity, nausea, and vomiting.
• Mysoline (primidone): Primidone is used alone or with other medications to treat epilepsy, often in children. Common side effects include dizziness and coordination problems.
• Topamax, Trokendi XR, Qudexy XR (topiramate): Used alone or with other medications, topiramate is used to treat generalized tonic-clonic seizures and focal seizures. It’s also used along with other medications to treat seizures in people with Lennox-Gastaut syndrome, as well as to prevent migraines. Common side effects include lack of appetite, weight loss, dizziness, tingling in the arms and legs, drowsiness, nervousness, speech problems, slowed reactions, and difficulty with memory.
• Trileptal (oxcarbazepine): This medication is used alone or with other drugs in adults and children. Common side effects include nausea, vomiting, sleepiness, vision problems, problems with walking and balance, and problems speaking, thinking, or concentrating.
• Gabitril (tiagabine): Tiagabine is usually used to treat focal seizures in children and adults. Common side effects include dizziness, drowsiness, concentration problems, nervousness, and tremor.
• Lamictal (lamotrigine): Used to treat seizures in both children and adults, lamotrigine is also used to treat bipolar disorder. Common side effects include sleepiness, coordination problems, blurry or double vision, headache, gastrointestinal problems, rash, and tremor.
• Zarontin (ethosuximide): This medication is used to treat absence seizures in children and adults. Common side effects include nausea, diarrhea, appetite loss, weight loss, hiccups, drowsiness, dizziness, headache, and concentration difficulties.
• Zonegran (zonisamide): Zonisamide is used with other medications to control seizures. Common side effects are nausea, weight loss, diarrhea, constipation, heartburn, dry mouth, headache, dizziness, confusion, fatigue, and double vision.
• Klonopin (clonazepam): Belonging to the benzodiazepines class of drugs, clonazepam is a sedative used alone or with other medications to treat seizures. Common side effects include drowsiness, dizziness, slurred speech, coordination problems, memory problems, and depression.
• Briviact (brivaracetam): This is a newer medication that was approved in 2016 to treat focal seizures, usually along with other medications. Common side effects include dizziness, sleepiness, nausea, and vomiting.
• Aptiom (eslicarbazepine): This medication is also used along with other medications to treat focal seizures. Common side effects are blurry or double vision, dizziness, sleepiness, and fatigue.
• Fycompa (perampanel): Perampanel is used for children and adults who are 12 years or older alone or with other medications for focal seizures and as an additional medication for people with generalized tonic-clonic seizures. Common side effects include dizziness, drowsiness, headache, nausea, vomiting, coordination problems, irritability, and anxiety.
• Epidiolex (cannabidiol): In 2018, the Food and Drug Administration (FDA) approved the use of Epidiolex, containing a cannabis-derived compound cannabidiol, also known as CBD, to treat the severe seizures associated with Lennox-Gastaut syndrome and Dravet syndrome in patients who are 2 years or older. (It’s now approved for one year or older.) It’s taken orally and doesn’t contain tetrahydrocannabinol (THC), the chemical that causes a high. This is the first FDA-approved drug that’s derived from cannabis (marijuana). When used along with other medications in studies, Epidiolex was shown to help reduce the frequency of seizures in patients with these two syndromes, which are notoriously difficult to control. Common side effects include drowsiness and lethargy, an elevation in liver enzymes, decreased appetite, diarrhea, rash, fatigue, weakness, sleep difficulties, and infections.

Generic Medications

In the United States, nine out of 10 prescriptions are filled with generic drugs. However, generic antiepileptic medications are associated with some problems.

Even though they contain the same active ingredient as brand names, the inactive ingredients in generics may vastly differ between brands. The amount of medication that your body absorbs may also differ. Also, while uncommon, it’s possible to be allergic to inactive ingredients.

The Epilepsy Foundation advises caution when switching from brand-name to generic medications or switching between generic brands. For people with difficult-to-control seizures, generic versions probably aren’t a good idea. However, if your seizures are generally well-controlled, a generic will likely be safe; just make sure that you talk to your pharmacist about getting your medication from the same manufacturer every time.

Always talk to your healthcare provider before making the jump to another brand or manufacturer. He or she may check the medication level in your blood before and after you switch to make sure you’re getting a therapeutic dose and, if not, adjust your dose or put you back on the brand name. Our Doctor Discussion Guide below can help you start that conversation.

Surgeries

In about 30–40% of people with epilepsy, two or more medications, together or separately, fail to control seizures. That’s known as drug-resistant or refractory epilepsy. If you’re in this subgroup, your healthcare provider may bring up surgery.

Surgery is recommended when you have a brain lesion, tumor, or mass that’s causing your seizures, as well as when you have focal seizures (only occurring in one part of your brain) that aren’t controlled with medications.

The right surgery for you will depend on what type of epilepsy you have, as well as the results of your pre-surgical evaluation and testing. Evaluation and testing help your healthcare provider locate the origins of your seizures and see how surgery may affect your everyday activities.

Testing may include electroencephalograms (EEGs), imaging tests to check for tumors or abscesses, and functional neurological testing to make sure that the surgery won’t affect abilities such as speaking and reading.

If you do have surgery, even if you’re seizure-free, you’ll still need to take anti-epileptics in general for at least one year. Surgery may also make it possible for you to take fewer medications and/or reduce your dose, though.

Four types of surgery are used to treat epilepsy.

Lobectomy

This is the most common type of epilepsy surgery, and it comes in two forms: temporal and frontal. Lobectomy is only for focal seizures, meaning that they start in a localized area of the brain.

Temporal lobectomy:

• Part of the temporal lobe is removed.
• High success rate
• Many patients have fewer seizures or become seizure-free.
• If medication is still needed, it’s usually a lower dose.

Frontal lobectomy:

• Part of the frontal lobe is removed.
• Lower success rate than temporal lobectomy
• Most have better seizure control after surgery.
• Some become seizure-free.

Multiple Subpial Transection

When your seizures start in an area of the brain that can’t be taken out, you may have multiple subpial transections.

• Involves shallow cuts in the cerebral cortex.
• Can lessen or stop seizures while keeping abilities intact.
• Temporarily successful for Landau-Kleffner syndrome (a rare form of epilepsy).

Corpus Callosotomy

The brain is made up of a left and right hemisphere. The corpus callosum connects and facilitates communication between them. However, the corpus callosum isn’t necessary to survive.

In a corpus callosotomy:

• Corpus callosum is severed either two-thirds of the way or completely.
• Lessens or stops communication between hemispheres
• Certain types of seizures can be stopped, and other types become less frequent.

This surgery is mostly done in children whose seizures start on one side of the brain and spread to the other. Usually, your surgeon will cut the front two-thirds first and only sever it completely if that doesn’t decrease the frequency of seizures.

Side effects include:

• Inability to name familiar objects seen on the left side of your visual field
• Alien hand syndrome (loss of ability to recognize and consciously control a part of your body, such as your hand)

Though this surgery can greatly reduce the frequency of seizures, it doesn’t stop the seizures in the hemisphere in which they start, and focal seizures may be even worse afterward.

Hemispherectomy

Hemispherectomy is one of the oldest surgical techniques for epilepsy. It involves:

• Disconnecting areas of the brain
• Removing tissue

In the past, most or all of the hemisphere was removed, but the procedure has evolved over time.

This surgery is usually used for children, but it can be helpful for some adults, too. A hemispherectomy is only performed if:

• Your seizures involve just one side of your brain
• They’re severe
• That hemisphere isn’t functioning well due to damage from injury or seizures, such as that associated with Rasmussen’s encephalitis.

The two most common types of hemispherectomy include:

• Anatomical: In this procedure, the frontal, parietal, temporal, and occipital lobes are removed from the hemisphere that’s causing seizures while leaving the brain stem, basal ganglia, and thalamus intact. It’s the most extreme form and may cause some loss of abilities, but people who have this surgery are often able to function well.
• Functional: This procedure involves removing a smaller section from the hemisphere responsible for seizures and disconnecting the corpus callosum.

Hemispherectomy can result in 60% or more patients becoming completely seizure-free. For patients who still have seizures after surgery, antiepileptic medication may be needed, but the dosage may be lower.

Seizures rarely get worse after this surgery. Sometimes, a repeat hemispherectomy is needed, and the outcome for this is also typically good.

Specialist-Driven Therapies

If surgery isn’t an option for you or you simply want to try other alternatives first, you have some other treatments to consider. These specialist-driven therapies are all adjunctive treatments, meaning that they are additions to drug therapies—not replacements for them.

Vagus Nerve Stimulation

Vagus nerve stimulation, also known as VNS therapy, is FDA-approved to treat seizures in adults and children over 4 years old whose seizures aren’t controlled after trying at least two medications.

Similar to a pacemaker, a vagus nerve stimulator is a small device that’s implanted under the skin on your chest and a wire runs to the vagus nerve in your neck. It’s unclear exactly how it works, but the stimulator delivers regular electrical pulses through the vagus nerve to your brain, lessening the severity and frequency of seizures. This may lead to needing less medication.

VNS therapy, on average:

• Reduces seizures by 20% to 40%
• Improves quality of life
• Tends to grow more effective over time

One review found that within four months after implantation:

• 49% of participants had a 50% or greater reduction in seizure frequency.
• Around 5% became seizure-free.

The same review also reported that 63% were doing just as well 24–48 months later, with around 8% achieving seizure freedom.

Responsive Neurostimulation

Responsive neurostimulation is like a pacemaker for your brain. It continuously monitors brain waves and analyzes patterns to detect activity that may lead to a seizure. Then, it responds with electrical stimulation that returns brainwaves to normal, preventing the seizure.

The device is adjusted to your individual needs, placed within your skull, and connected to one or two electrodes on your brain.

This therapy is for people whose seizures aren’t controlled after trying at least two medications. It’s FDA-approved for adults with focal epilepsy, and, as with VNS therapy, the effects seem to get better over time.

Deep Brain Stimulation

In deep brain stimulation (DBS), electrodes are placed in a specific part of your brain, often the thalamus. They’re connected to a device that’s implanted under the skin in your chest that sends electrical impulses to your brain. This can lessen or even stop seizures.

The FDA has approved this treatment for adults with focal epilepsy that isn’t controlled after trying three or more medications.

These effects also appear to increase with time. In one study:

• After a year of DBS, 43% of participants reported a 50% or more decrease in seizures.
• After five years, 68% reported the same decrease.
• Within those five years, 16% went six months or more without any seizures.
• Quality of life reports also improved over time.

Diets

Dietary changes may help in the management of your condition but should never be considered a sole treatment option. These should only be considered with your healthcare provider’s input and monitoring, as well as the help of a dietitian.

Ketogenic Diet

The ketogenic diet is often prescribed in cases where seizures aren’t responding to two or more medications, particularly in children. This high-fat, low-carbohydrate diet is strict and can be difficult to follow. It’s especially helpful for certain epilepsy syndromes and makes it possible for some people to take lower doses of medications.

Studies show:

• In one study, almost half of children on the ketogenic diet saw a 50% or greater reduction in seizures.
• In adults, this diet reduces seizures by 50% or more in between 22% and 70% of patients and by 90% or more in up to 52% of patients.
• A small percentage of both children and adults may become seizure-free after several years on a closely supervised ketogenic diet.

Potential side effects include:

• Dehydration
• Constipation
• Higher cholesterol in adults
• Stunted growth in children due to nutritional deficiencies

Modified Atkins Diet

The modified Atkins diet (MAD) is a less restrictive and newer version of the ketogenic diet that can be used for both adults and children.

While the foods are similar to the ketogenic diet, fluids, proteins, and calories aren’t restricted, and there’s more freedom when it comes to eating out. The MAD encourages fewer carbohydrates and more fat than the standard Atkins diet.

This diet seems to have similar results to the classic ketogenic diet. One study found that:

• Seizures are reduced by 50% or more in between 12% and 67% of adults.
• Up to 67% of adults have 90% or better seizure reduction.

Potential side effects include weight loss, higher cholesterol in adults, and feeling ill, especially at first.

Low Glycemic Index Diet

Another less restrictive version of the ketogenic diet, the low glycemic index treatment (LGIT) focuses more on carbohydrates that have a low glycemic index. It doesn’t restrict fluids or protein, and food is based on portion sizes rather than weights.

There haven’t been many high-quality studies done on the effects of LGIT, but it seems to be beneficial in reducing seizures.

Gluten-Free Diet

Some research shows that the rate of celiac disease (an autoimmune disorder that causes gluten sensitivity) is significantly more common in people with epilepsy than in the general public. This has led to speculation that gluten may have a role in causing or contributing to the development of seizures.

A large 2020 study found that children with celiac disease were about twice as likely to have epilepsy as children without celiac disease.

Still, it’s difficult to establish a link between gluten sensitivity and seizures because there’s currently no standard measure of gluten sensitivity outside of celiac disease.

While this is an area with little research, you can find lots of anecdotes about people who say they’ve stopped having seizures after going gluten-free. Claims are especially rampant when it comes to children, with some people proclaiming the diet more effective than drugs.

It’s tempting to believe these kinds of success stories, but it pays to remember that seizure frequency often decreases over time, and early childhood epilepsy often goes away on its own.

Until more research is available, the impact of a gluten-free diet on epilepsy remains speculative. If you decide to try this diet, make sure to discuss it with your healthcare provider to make sure you’re not harming yourself by eliminating important nutrients, which could exacerbate your epilepsy.

Lifestyle

Adopting healthy habits may help control your epilepsy, as well.

Get Enough Sleep

Sleep deprivation can trigger seizures in some people, so make sure you get enough. If you have trouble getting to sleep or wake up often, talk to your healthcare provider. You can also try to:

• Limit caffeine after lunch, eliminate it after 5 p.m.
• Turn off electronic devices with blue light an hour before bed
• Create a nightly bedtime ritual
• Give yourself at least an eight-hour window to sleep
• Make your room as dark as possible; consider room-darkening shades or blinds
• Keep your bedroom cool
• Avoid alcohol before bed
• Try not to nap
• Wake up at the same time every morning

Manage Stress

Stress is another potential trigger for seizures. If you’re under too much stress, try delegating some responsibilities to others.

Learn relaxation techniques such as deep breathing, meditation, and progressive muscle relaxation. Take time out for activities you enjoy and find hobbies that help you unwind.

Exercise

Besides helping you stay physically healthy, exercise can also help you sleep better, boost mood and self-esteem, reduce anxiety, relieve stress, and stave off depression.

Don’t exercise too close to bedtime, though, or you may have trouble drifting off.

Take Your Medications

Be sure to take your medications exactly as prescribed so you can attain the best seizure control possible. Don’t ever change your dose or stop taking your medication without consulting your healthcare provider.

Depending on your epilepsy type, you may eventually go without seizures for long enough that you can try going off your meds. This should only be done with your healthcare provider’s permission and supervision.

Complementary Medicine

There are some complementary and alternative medicine (CAM) treatments that you may want to consider including alongside (not in place of) your regular therapies.

Music

Studies on the relationship of music to seizures suggest that regularly listening to Mozart, particularly Mozart’s Sonata for Two Pianos in D Major (K. 448), helps reduce seizures and EEG abnormalities in children. This is called the Mozart Effect.

One study of both children and adults who listened to Mozart K. 448 for 10 minutes three times a week for three months showed that the effect was 25% more prevalent in children. However, both groups had fewer EEG abnormalities and decreased seizures.

It’s not clear what the relationship is between the music and the decrease in seizure activity, and more research is needed to confirm this effect altogether.

Yoga

A Cochrane review on yoga for epilepsy concluded that it may be beneficial in controlling seizures, but there isn’t sufficient evidence to recommend it as a treatment.

Yoga should only be used along with your regular treatments, never by itself. An additional benefit is that yoga can help you manage stress.

Biofeedback

Also known as neurofeedback, biofeedback is a technique that allows you to measure your body’s responses to seizure triggers (among other things). With time, you can use this information to help control automatic functions such as your heart rate and respiration, potentially reducing the frequency of seizures.

Biofeedback uses sensors attached to your body, so it’s non-invasive. It also has no side effects.

Multiple small studies have shown that it does help reduce seizures. This seems to be especially true with biofeedback using galvanic skin response (GSR), which measures the amount of sweat in your hands. Still, more studies need to be done.

Blue-Tinted Lenses

Some evidence suggests that wearing sunglasses with blue-tinted lenses may help people with photosensitive epilepsy, but the research is limited and out of date.

Blue-tinted lenses haven’t been approved by the FDA for the treatment of seizures, but there’s no harm in trying them as long as you don’t stop regular treatments. The Zeiss Z-1 lenses mentioned in a widely-cited 2006 study have to be purchased from outside the United States, but you can get TheraSpecs fluorescent light glasses online. They’re not blue-tinted, but they block blue-green light.

Art

Epilepsy can have a marginalizing effect that may lead to feelings of sadness and low self-confidence. Preliminary research suggests that a multi-week art therapy program called Studio E: The Epilepsy Art Therapy Program may help boost self-esteem in people with epilepsy.

Among the 67 people who enrolled in the pilot study, the program appeared to boost self-esteem as measured by the Rosenberg Self-Esteem Scale (RSES). The drop-out rate was low, as well.

The Future of Treatment

A lot of work is being done in the quest for less invasive and more effective epilepsy treatments, including a few things that are still in experimental stages.

Stereotactic Radiosurgery

Stereotactic radiosurgery, or stereotactic laser ablation, may help people who:

• Have focal seizures
• Don’t respond well to medications
• Aren’t good surgery candidates

During the procedure, targeted radiation destroys tissue in the part of the brain that causes seizures. Preliminary evidence shows that it’s effective for controlling seizures in the mesial temporal lobe, the most common type of focal epilepsy.

Thermal Ablation

Also known as laser interstitial thermal therapy or LITT procedure, thermal ablation is an advanced form of stereotactic radiosurgery that uses magnetic resonance imaging (MRI) to locate the tissue to be destroyed. It’s much more precise and has fewer risks than traditional surgery.

External Nerve Stimulation

External trigeminal nerve stimulation (eTNS) is similar to vagus nerve stimulation, but the device is worn externally rather than implanted.

One specific device, the Monarch eTNS System, has been approved in Europe and Canada and is being researched in the United States.

A 2015 study concluded that long-term evidence showed the treatment was safe and a “promising long-term treatment” for people whose epilepsy isn’t well controlled by drugs.

A 2017 audit of the treatment in Britain found that people without intellectual disabilities had a significant improvement in both quality of life and mood, as well as an 11% decrease in seizures. The authors declared it safe and flexible but also stated the need for further controlled studies to confirm its effectiveness.

Subthreshold Cortical Stimulation

Subthreshold cortical stimulation uses electrodes connected to a generator. Instead of waiting until your brain exhibits abnormal activity, it prevents seizures by providing continuous stimulation to the precise area of your brain in which seizures start.

In one study, 10 out of 13 participants who had the treatment said their epilepsy became less severe. Most of them also had at least a 50% reduction in seizure frequency. This treatment may be especially helpful for people with focal epilepsy who aren’t candidates for surgery.