Epilepsy Treatments and Medications

Living with recurring seizures and moments of unconsciousness can be frustrating and scary. These symptoms typically indicate a case of epilepsy, which can be confirmed through lab tests after speaking with your doctor.

Understanding what epilepsy is and the at-home and prescription medication treatment options available are the first steps in managing your condition.

There are various types of epilepsy or types of seizures one can experience. Focal or partial seizures occur when the electrical activity prompting the seizures is localized to a particular part of the brain. Generalized seizures are the opposite, where there is widespread activity across multiple areas of the brain. Types of generalized seizures include absence seizures (or petit mal seizures), tonic-clonic seizures (or grand mal seizures), atonic seizures, clonic seizures, tonic seizures, and myoclonic seizures.

In 2015, there were 3.4 million adults and 470,000 children with active epilepsy in the United States, according to the CDC. Epilepsy used to be a mysterious condition that was difficult to diagnose and treat, especially because approximately one-third of patients develop drug-resistant seizures. But with medical advancements in the past decade, new technologies are helping to make treatment more effective.

New research and development for epilepsy is focusing on pinpointing the source of epileptic seizures, particularly for those who have drug-resistant epilepsy and offering less-invasive options than surgical treatment. Technologies like stereo-electroencephalography (SEEG), laser ablation, and responsive neurostimulation are all being developed to tackle different facets of the condition.

SEEG is a diagnostic tool that uses thin electrodes in the head to monitor brain activity and find the causes for one’s seizures. Laser ablation is a treatment method that is then used to target the brain tissues where the seizures originate with thin lasers. Neurostimulation is an option for controlling seizures by implanting a device in the brain that delivers electrical impulses to reduce seizures. Clinical trials have shown these devices can reduce seizures by up to 80 percent.

When you speak with your primary care provider about your seizures, the provider will ask you questions about what happened leading up to, during, and after the seizures to try to understand the cause. Your provider will likely refer you to a specialist such as a neurologist or an epileptologist who focuses on treating nervous system disorders like epilepsy.

Lab tests or imaging are often required to diagnose epilepsy. One of the most common tools used to diagnose epilepsy is an electroencephalogram (EEG) test. During an EEG, electrodes are attached to the scalp to record your brain’s electrical activity and monitor for irregularities. Other tests for diagnosing epilepsy may include blood tests, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.

Blood tests may be used to detect levels of the hormone prolactin in the blood. CT and MRI scans are used to reveal any abnormalities or lesions in a particular area of the brain that could cause seizures such as cysts, tumors, and bleeding.

The most common treatment methods for epilepsy include anti-epileptic drugs (AEDs), epilepsy surgery, and device therapies such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS), and dietary changes like the ketogenic diet.

There is no current cure for epilepsy, but treatment can help control your seizures. Preventative methods may also help to reduce the frequency of epileptic episodes. These methods include sleeping regularly, managing stress, eating healthy, avoiding illicit drugs and alcohol, and avoiding bright, flashing lights.

Seizures can occur either in a localized section of the brain (focal epilepsy) or throughout the brain (generalized epilepsy). People who typically experience focal epilepsy may be prescribed a narrow-spectrum AED like Neurontin (gabapentin) or Lyrica (pregabalin). Those who experience generalized epilepsy may be prescribed broad-spectrum AEDs like Felbatol (felbamate), Keppra (levetiracetam), Topamax (topiramate) or Depakene (valproic acid).

The common mild side effects of anticonvulsant drugs include nausea, abdominal pain, dizziness, mood changes, sleepiness, and trouble concentrating. Some may experience more severe side effects, such as blood problems, liver problems, or more seizures. Your doctor can help explain the potential risks and benefits of any prescribed medications. Be sure to contact your primary care provider if you experience any unusual side effects after starting medication.

Phenobarbital has a long history of effective use for epilepsy treatment and is low-cost, but it is also a habit-forming drug that can cause withdrawal seizures. Your doctor may recommend a slow reduction in dosage to avoid withdrawal symptoms.

“Medications prescribed for epilepsy depends on many factors. The type of seizure/epilepsy, the severity, and the frequency of seizures, other illnesses the patient might have, how the patient responds to certain medications, side effect tolerance and so on,” says Dr. Menon.

Some patients require multiple medications to control seizures. Consult with your doctor to determine the best epilepsy medication for you.

See common epilepsy medications in the comparison chart below.

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

When starting medication for the first time, you may experience some of these mild side effects. More serious and less common side effects of epilepsy medications include increased seizures, a drop in white blood cells or platelets, and problems with the liver or pancreas.

The side effects of epilepsy medication can be far-ranging and more extensive than those listed above, particularly if you take other medications that may be interacting with the epilepsy drugs. It’s important to speak with your healthcare provider about the benefits and risks of prescription medications. If you experience an adverse reaction to a new drug, consult with your doctor before stopping treatment.

Vitamin B-6 can be used to treat a rare form of epilepsy (pyridoxine-dependent seizures) that’s caused by the body’s inability to metabolize the vitamin properly. Deficiencies in magnesium and vitamin E are often associated with seizures, and using these supplements has been shown to reduce episodes.

Vitamin D and folic acid are a few other essential vitamin supplements that may help to reduce seizures. Before using any vitamins, it’s best to speak with your doctor about how they may affect your treatment and interact with other medications.

There are some common herbs that are known to worsen seizures or negatively interact with anti-seizure medications. These herbs that you should avoid include ginkgo biloba, St. John’s wort, garlic, chamomile, mint tea, kava, passionflower, valerian, schizandra, guarantor, and kola. As with any natural supplement, it is vital that you discuss herbal remedies with your doctor before adding to your treatment regimen.

Doctors don’t exactly know how this diet works to reduce seizures, but due to its success, it is commonly recommended, especially for children as an alternative or as a complementary approach with prescription medication.

The modified Atkins diet is a low-carb, high-fat alternative to the keto diet that is less restrictive and also effective in reducing seizures within the first few months.

The process works by using electrical sensors to monitor your brain activity and then train yourself to stabilize abnormal circuits. Biofeedback may be a time-intensive and challenging process, and it’s difficult to manage epilepsy with this technique alone, but it is proven to be effective in helping people reduce seizures.

Frequently asked questions about epilepsy