- Epilepsy treatments usually start with antiseizure medications to help reduce the frequency and intensity of seizures.
- Other options include a ketogenic diet, cannabidiol, nerve stimulation, or surgery.
- Treatment during pregnancy should be carefully planned with a neurologist, as some medications may affect fetal development.
Epilepsy treatment usually involves antiseizure medications, such as carbamazepine, valproic acid, or phenytoin. These medications help control nerve signals in the brain, which can reduce the frequency and intensity of seizures.
When medication alone is not enough to prevent seizures, a doctor may recommend other epilepsy treatments. These may include cannabidiol, vagus nerve stimulation, or even brain surgery, depending on the severity of each person’s seizures.
Epilepsy treatment should always be guided by a neurologist. Treatment may vary depending on the type of epilepsy, the severity of the condition, seizure frequency, age, and, in women, pregnancy or plans to become pregnant.
Main treatments
The main epilepsy treatments are:
1. Antiseizure medications
Antiseizure medications, also called anticonvulsants or antiepileptic drugs, are usually the first treatment option for epilepsy. They help control or prevent seizures by changing neurotransmitter activity in the brain.
The main antiseizure medications that may be prescribed by a neurologist include:
Antiseizure medication should always be adjusted under the guidance of a neurologist. The doctor may increase the dose according to how well the seizures are controlled and, in some cases, may prescribe a combination of two different medications.
Other antiseizure medications that may be prescribed include oxcarbazepine, lacosamide, or zonisamide.
Although these medications can be effective, long-term use may cause side effects such as tiredness, reduced bone density, speech problems, memory changes, and even depression. Therefore, if seizures remain controlled for 2 years, the doctor may consider stopping the medication.
2. Ketogenic diet
The ketogenic diet for epilepsy is based on a high-fat diet, with a moderate amount of protein and a low amount of carbohydrates.
This type of diet causes the body to enter ketosis, which makes the brain use ketone bodies as its main source of energy. This can help control seizures.
There are two types of diet that may be recommended:
-
Classic ketogenic (keto) diet: 90% of calories come from fats such as butter, oils, heavy cream, and olive oil. The other 10% come from proteins such as meat and eggs, and carbohydrates such as fruits and vegetables.
-
Modified Atkins diet: 60% of calories come from fats, 30% from protein-rich foods, and 10% from carbohydrates.
The ketogenic diet is recommended for refractory epilepsy, which is a type of epilepsy that is difficult to control. It should be followed under medical and dietitian supervision for about 2 to 3 years, after which a regular diet may be gradually reintroduced while monitoring whether seizures return.
3. Cannabidiol
Cannabidiol may be prescribed for specific seizure disorders that do not improve with medication. It acts on the endocannabinoid system in the brain and can help reduce seizures.
According to the FDA-approved prescribing information, prescription cannabidiol oral solution is approved only for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex in people 1 year of age and older.
Cannabidiol has also been studied as an alternative to vagus nerve stimulation therapy.
4. Vagus nerve stimulation
Vagus nerve stimulation may be used as an alternative to medication, but it can also be used together with medication when seizure reduction is still not enough.
In this treatment, a small device similar to a pacemaker is placed under the skin in the chest. Wires are then connected to the vagus nerve, which runs through the neck.
The electrical current that passes through the nerve can help reduce seizure intensity by up to 40%. However, it can also cause side effects such as throat pain or shortness of breath.
5. Brain surgery
Surgery is usually only done when no other treatment has been enough to reduce the frequency or intensity of seizures.
In this type of surgery, the neurosurgeon may:
-
Remove the affected part of the brain: as long as it is a small area and does not affect overall brain function
-
Implant electrodes in the brain: these help regulate electrical impulses, especially after a seizure begins
In most cases, medication is still needed after surgery. However, the doses can usually be reduced, which also lowers the risk of side effects.
6. Physical activity
Physical activity can help improve well-being and social interaction. It may be recommended for people with controlled seizures, but only if approved by a neurologist.
However, some physical activities are not recommended, such as skydiving, mountain climbing, scuba diving, hang gliding, or swimming or cycling for children with uncontrolled absence seizures.
It is important to tell the fitness professional that you have epilepsy, are receiving treatment, and have controlled seizures. They should also know what to do if a seizure occurs.
Treatment during pregnancy
Epilepsy treatment during pregnancy should be carefully planned with a neurologist, as some antiseizure medications may affect fetal development or increase the risk of birth defects. However, medication should not be stopped without medical guidance, because uncontrolled seizures can also pose risks during pregnancy.
Pregnant people who have regular seizures and need medication to control them should speak with their neurologist. According to the 2024 AAN/AES/SMFM guideline, valproic acid should generally be avoided during pregnancy when clinically feasible, and people taking antiseizure medications should take at least 0.4 mg of folic acid daily before and during pregnancy.
They should also take at least 0.4 mg of folic acid daily before and during pregnancy, or a different dose if recommended by their neurologist or OB-GYN. Vitamin K may be recommended during the last month of pregnancy.
One way to help control seizures during pregnancy is to avoid epilepsy triggers and use relaxation techniques to reduce stress.
Self-care measures
Some daily care measures are recommended for people with epilepsy, such as:
-
Taking medication at the times recommended by their doctor
-
Going to regular medical appointments and completing the tests recommended by their doctor
-
Identifying what may trigger seizures by keeping a daily routine journal, so situations that cause seizures can be avoided
-
Exercising regularly, as recommended by a doctor
It is also important to keep a card in a wallet or bag stating that the person has epilepsy, along with emergency contact information.
People with epilepsy can live a normal life as long as they follow medical guidance to prevent seizures and epilepsy complications.
Foods to avoid
A person with epilepsy who is following a ketogenic diet, as advised by a registered dietitian, should strictly limit carbohydrates, including foods such as bread, cakes, pasta, and rice.
It is important to check food labels carefully and avoid products with added sugars or hidden carbohydrates, such as dextrose, sucrose, glucose, fructose, maltose, and sugar alcohols like sorbitol and mannitol.
In addition, vitamin supplements and medications should be free of added sugars whenever possible, to help maintain ketosis.
Is epilepsy curable?
Epilepsy does not have a definitive cure, but it can be controlled with treatment prescribed by a doctor to regulate brain activity and prevent new seizures.
Epilepsy is caused by abnormal electrical impulses in neurons and chemical signals in the brain. This can lead to symptoms such as seizures, uncontrolled body movements, and even loss of consciousness.