Doctors usually treat epilepsy with antiepileptic drugs first, and may recommend surgery or other therapies if the drugs don’t work.
1. Medications
Most patients taking an antiepileptic drug will stop the seizures, and others will have a reduction in seizure frequency or intensity. More than half of those who take medications in childhood that are effective in controlling seizures can eventually stop taking them and have no more seizures in their lifetime. Many adults can also discontinue their medications after 2-3 years of seizure cessation.
Choosing the right medication or dose is not easy. Doctors usually start with one medication in a small dose and gradually increase it until the seizures are controlled.
All antiepileptic drugs have some side effects.
The milder ones include: fatigue, dizziness, weight gain, decreased bone density, skin rash, coordination problems, and speech problems
More serious but rare ones include: depression, suicidal tendencies, severe skin rash, organ inflammation such as pancreas, liver.
To achieve the best results with medication, it is necessary to
Using the medication exactly as prescribed by the doctor
Tell your doctor before changing the medication used, taking other prescription drugs, over-the-counter drugs, or herbal medicines
Do not discontinue antiepileptic drugs without a doctor’s recommendation
Tell your doctor immediately if you observe depression, suicidal tendencies, unusual moods or behaviors
In at least half of patients, the first dose of one antiepileptic drug stops the seizures. If there is no good outcome with several antiepileptic drugs, the doctor may recommend surgery or other therapies
2. Surgery
Surgery may be considered if tests show that the epilepsy originated in a small, well-defined lesion in the brain and that this area does not interfere with important functions such as speech or hearing. During surgery, the surgeon will remove this part of the brain tissue that is causing the epilepsy.
If the epilepsy originates in an area of the brain that cannot be removed, the surgeon may recommend other surgical methods, such as making some incisions in the brain tissue to stop the spread of seizures in the brain.
Although many patients will continue to take some medication to prevent seizures after successful surgery, the amount and dose of medication may be reduced. In a few cases, epilepsy surgery can cause some complications such as permanent cognitive changes. Before considering surgery, it is important to know the surgeon’s experience, success rate and complications of this type of surgery.
3. Other treatments
Vagus nerve stimulation
In this method, a vagus nerve stimulator, like a pacemaker, is implanted under the skin in your chest. The wires coming from the stimulator are wrapped around the vagus nerve in the neck. A battery-operated device, which releases short pulses, transmits electrical energy through the vagus nerve to brain tissue. How this method stops seizures is not well understood, but seizures can stop completely in about 5% of patients and can be reduced by 20-40% in others. Most patients will still need to take anti-seizure medication. Side effects of vagus nerve stimulation include hoarseness, sore throat, cough, shortness of breath, and muscle pain.
Ketogenic diet
In some children, a high-fat, low-carbohydrate diet can reduce seizures. This diet allows the body to use fat rather than carbohydrates to produce energy, and some children with this type of diet can be discontinued after several years and continue to be seizure-free.
If you are considering a ketogenic diet, you need to discuss it with your doctor to avoid malnutrition. Side effects may include: dehydration, constipation, slow growth, and increased uric acid in the blood leading to kidney stones.