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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 anti-convulsants, 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 seizure drugs 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. No one should stop taking or change seizure drugs without talking with their doctor first.

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy." Some people 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 Atkin's diet, may also be helpful in some adults.

People 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.

Expectations (prognosis):

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 lifelong condition. In these cases, the seizure drugs need to be continued.

Death or permanent brain damage from seizures is rare, but can occur if the seizure is prolonged or two or more seizures occur close together (status epilepticus). 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 may not be able to 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 causes 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 (911) if this the first time a person has had a seizure or a seizure is occurring in someone without a medical ID bracelet (instructions explaining what to do). In the case of someone who has had seizures before, call the ambulance 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.

  • Reviewed last on: 5/29/2008
  • Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Foldvary-Schaefer N, Wyllie E. Epilepsy. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 52.

Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1996-2007.

Spencer SS. Seizures and epilepsy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 426.

Tomson T, Hiilesmaa V. Epilepsy in Pregnancy. BMJ. 2007;335(7623):769-73.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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