There are different types of seizures with many treatment options to consider. The goal of all epilepsy treatment is to stop the seizures with as few side effects as possible. In all cases, it is important to take medications and follow the treatment plan in order to reduce the risk of Sudden Unexpected Death in Epilepsy (SUDEP).
The most common form of treatment is anti-seizure medication. Other forms of treatment, including surgery, a special diet, or implants may be tried if medication is not successful in reducing or eliminating the seizures.
The most common first treatment is medication. There are currently more than 30 medications available to treat seizures. The doctor will choose the best one depending on the seizure type and syndrome, as well as possible side effects or other medications a person might be taking. Most types of medications are taken by mouth in the form of tablets, capsules, sprinkles, or syrup.
Different people react in different ways to anti-seizure medications. One drug may effectively control one person’s seizures, while that same drug may not work at all for another person. A person may need to try several different medications before finding a treatment that works to control seizures without negative side effects. Do not feel discouraged; this is typical for many people. Often, doctors will prescribe more than one kind of seizure medication because together they may work better than any of the medications taken alone. It is important to stay optimistic and patient during this time.
Taking medication at the prescribed time every day is an important part of the treatment. The medicine taken every day replaces what has been used by the body, keeping the medication level at the correct therapeutic level in the bloodstream. Skipping a dose, taking fewer pills than prescribed, or not filling a prescription on time can cause the medication level to be too low in the blood, increasing the risk of a seizure.
Doctors may order periodic blood tests to measure how much medication is in a person’s system. This process is often referred to as obtaining a blood level. Typically, a provider will ask to have the blood level drawn prior to a dose of medication; this is referred to as a trough level. These tests will help the doctor to know if the amount of anti-seizure medication taken is the right amount. The goal is to give the amount of medication that stops the seizures without creating any side effects. This amount is called a therapeutic level and is different for every person. A dose of medication that makes a person feel sick because it is too much is called a toxic level. The toxic level for each person is different, too.
All medicines can cause side effects, including drugs to prevent seizures. Sometimes, the side effects go away after a while. Other side effects might happen because an anti-seizure drug is interacting with another drug that a person is taking, or an anti-seizure drug may be building up in the body, reaching a toxic level. If any side effects occur, such as nausea, feeling very tired, staggering, slurred speech, or a rash, the person should contact their physician right away.
A special diet may be prescribed (mostly for children) when seizures have not responded to anti-seizure medications or other forms of treatment alone.
Prescribed by a doctor, the ketogenic diet is an extremely strict diet that helps to stop or control seizures for some children. It should be treated like a serious medication and must be closely supervised by a dietician, physician, and the child’s family. The diet is carefully tailored for the individual child, and the types and amounts of food the child eats must be strictly regulated.
The diet, which is very high in fat and very low in proteins and carbohydrates, produces a change in the child’s body chemistry called “ketosis.” Ketosis has an anti-seizure effect in about 2 out of every 3 children who try the diet. Not all doctors agree that this diet is good for children who have seizures.
The ketogenic diet is prescribed for children for a limited amount of time. After remaining on the diet for a while, doctors and the dietician will want to slowly taper off the diet and reintroduce regular food. If seizures return, the diet may be reinstituted. Studies are being conducted now to determine if the ketogenic diet may be an effective form of treatment for adults.
With VNS, a surgeon implants a small device with a wire and battery (about 2 inches in diameter) in the upper left chest. The device sends regular bursts of electricity at a regular interval along the left vagus nerve in the neck, via some electrodes that doctors will wrap around the nerve. This regular flow of electricity along this particular nerve has an anti-seizure effect in some patients who try it as a form of treatment.
If a person has a VNS and experiences an aura, or senses that they are about to have a seizure, they can swipe a specially designed magnet over the implant, which will trigger it to send some electricity along the vagus nerve. Hopefully, this electricity will prevent the seizure from happening. Family, friends, and caregivers can also swipe the magnet over the implant during a seizure in the hopes of reducing the length or severity of the seizure.
Some of the newer VNS devices can detect changes in heart rate that are associated with seizures, and will automatically send an extra signal/stimulation. [The VNS is used in addition to anti-seizure medications.] The newest VNS device is approved for children as young as 4.
This device is produced by LivaNova: us.livanova.cyberonics.com
This device, currently only approved for adults 18 years and older, is used in addition to anti-seizure medications. With an RNS device, a surgeon places the neurostimulator under the scalp in the skull, with one or two wires that connect to the part of the brain where seizures start. The device records brain activity and senses when a seizure is about to start. It then sends pulses of electricity to stop or lessen the seizure.
The device is produced by NeuroPace: www.neuropace.com
Brain surgery can be an effective treatment for epilepsy, but it isn’t right for everyone. Generally, doctors will consider many factors first and will recommend surgery only as a last resort. The doctor may suggest surgery when:
Surgery for epilepsy will most likely be performed at special medical centers, rather than local hospitals. In addition to operations that remove part of a patient’s brain, other types of surgeries can be performed to interrupt the spread of electrical disturbances in a person’s brain.
Patients are often awake during brain surgery since the brain does not feel any pain. Having the patient stay awake helps the surgeons make sure that important parts of the brain are not being damaged during the operation.
After brain surgery for epilepsy, a patient will most likely still have to take anti-seizure medications for a year or two. If no seizures occur during this time, the doctor may slowly wean the person off of the medication. Some people are able to live seizure- and medication-free from this point on; however, many people still need to take their anti-seizure medication(s), and some have seizures that continue.