Epilepsy Treatment: Medication, Surgery, Diet, and More

When seizures are determined to be caused by epilepsy, the first line of treatment is usually medication. There are more than 20 different anti-seizure medicines available. Some may work better for certain types of seizures than for others, and all have side effects.

The goal is to strike a balance between the upside of fewer seizures — and better quality of life — and the downside of bothersome medication side effects.

If medication proves ineffective at controlling seizures, other treatments may be required, such as epilepsy surgery, dietary changes, vagus nerve stimulation (VNS) therapy, or responsive neurostimulation.

But before you stop taking an anti-seizure medication for any reason — including continued seizures, unacceptable side effects, or any other reason — talk to your doctor about stopping the drug or changing therapies. Don’t stop an anti-seizure drug on your own.

Normally, anti-seizure drugs are tapered — taken in progressively smaller doses — before they are stopped entirely. Abruptly stopping a medication raises the risk of withdrawal seizures.

Medication for Epilepsy

Usually, a person with epilepsy will be started on one medication (“monotherapy”) at a low dose, and then the dosage will be gradually increased to find the proper dose for that person. This is done to try to minimize side effects. Almost half of people with epilepsy become seizure-free with monotherapy.

Side effects from anti-seizure drugs (also called anti-epileptic drugs, or AEDs) are common, often leading to a reduced quality of life in people with epilepsy. Drowsiness, dizziness, double vision (diplopia), and impaired balance are common problems with all classes of anti-seizure medication.

Other side effects are more specific to individual drugs, but common side effects can include difficulty concentrating, nausea, tremors, rash, weight gain or loss, and suicidal thoughts.

Some people are eventually able to stop anti-seizure medication, but the ability to do so varies with age and type of seizure. One study showed that 75 percent of people who had been seizure-free for three years could discontinue medication without having more seizures. (1)

For about 1 out of 3 people with epilepsy, seizures are not controlled by medication. These people are referred to as having drug-resistant or “refractory” seizures.

Because using multiple anti-seizure drugs can lead to severe side effects, other treatments are often tried for refractory seizures.

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