Epilepsy : Treatment

Treatment

For treatment of seizures, please see Seizures – first aid.

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems.

Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. These drugs are taken by mouth.

• The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time.
• Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.
• It is very important that you take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage.
• You should not stop taking or change medications without talking to your doctor first.

Some factors increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

• Certain prescribed medications
• Emotional stress
• Illness, especially infection
• Lack of sleep
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

Epilepsy that does not get better after two or three seizure drugs have been tried is called “medically refractory epilepsy.”

• Some patients with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures.
• Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults.

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.

Support Groups

The stress caused by having seizures (or being a caretaker of someone with seizures) can often be helped by joining a support group. In these groups, members share common experiences and problems. See: Epilepsy – support group

In addition to groups that meet face-to-face, there are many discussion groups and bulletin boards on the Internet where people with epilepsy can find support.

Prognosis (Expectations)

Some people with certain types of seizures may be able to reduce or completely stop their seizure medicines after having no seizures for several years. Certain types of childhood epilepsy goes away or improves with age — usually in the late teens or 20s.

For some people, epilepsy may be a lifelong condition. In these cases, the seizure drugs need to be continued.

Death or permanent brain damage from seizures is rare. However, seizures that last for a long time or two or more seizures that occur close together (status epilepticus) may cause permanent harm. Death or brain damage are most often caused by prolonged lack of breathing, which causes brain tissue to die from lack of oxygen. There are some cases of sudden, unexplained death in patients with epilepsy.

Serious injury can occur if a seizure occurs during driving or when operating dangerous equipment. For this reason, people with epilepsy whose seizures are not under good control should not do these activities.

People who have infrequent seizures may not have any severe restrictions on their lifestyle.

Complications

• Difficulty learning
• Inhaling fluid into the lungs, which can cause aspiration pneumonia
• Injury from falls, bumps, or self-inflicted bites during a seizure
• Injury from having a seizure while driving or operating machinery
• Many epilepsy medications cause birth defects — women wishing to become pregnant should alert their doctor in advance in order to adjust medications
• Permanent brain damage (stroke or other damage)
• Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
• Side effects of medications

Calling Your Health Care Provider

Call your local emergency number (such as 911) if this is the first time a person has had a seizure or if a seizure is occurring in someone without a medical ID bracelet (which has instructions explaining what to do).

In the case of someone who has had seizures before, call 911 for any of these emergency situations:

• This is a longer seizure than the person normally has, or an unusual number of seizures for the person
• Repeated seizures over a few minutes
• Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

• Epilepsy : Overview, Causes, & Risk Factors

• Epilepsy : Symptoms & Signs, Diagnosis & Tests

• Epilepsy : Treatment

Review Date : 3/29/2009
Reviewed By : Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Previously reviewed by Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. (6/19/08)

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