Epilepsy - Treatment 

Treating epilepsy 

Treatment for epilepsy is generally used to control seizures, although not everyone with the condition will need to be treated.

If seizures are not intrusive and only last for a short while, treatment may not be necessary.

Also, it may be possible to control your epilepsy by avoiding things that trigger your seizures, such as sleep deprivation and alcohol.

While some people may need to be treated for the rest of their lives, this is not always the case. Sometimes people have epileptic seizures at one stage in their life, only for them to become less frequent or disappear as they get older. This is more common if seizures first occur in childhood or early-adulthood.

Good epilepsy care

The Department of Health has developed a National Service Framework (NSF) for long-term conditions. This gives guidance to doctors, nurses and healthcare staff on how to provide care to patients. It was developed in consultation with people with long-term neurological conditions, including epilepsy. It tells staff how to give services that are co-ordinated, matched to people’s needs, and easy to use.

Patients can also use the National Service Framework. It can:

  • provide information and support to help you make decisions about your care
  • give you a choice about how and where you get treatment and care
  • help you live more independently

The National Institute for Health and Clinical Excellence (NICE) has published guidelines on the diagnosis and care of children and adults with epilepsy.

The guidelines give comprehensive and objective information on the benefits and limitations of the various ways of diagnosing, treating and caring for people with epilepsy. They can help health professionals and patients decide on the most appropriate treatment.

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Treatment overview  hide

Anti-epileptic drugs (AEDs) are usually the first choice of treatment. About 70% of people with epilepsy have their seizures controlled with AEDs.

Usually, AED treatment will not begin until after you have had a second seizure. This is because a single seizure is not a reliable indicator that you have epilepsy. In some cases, treatment will begin after a first seizure if:

For some people, surgery may be an option. However, this is only the case if removing the area of the brain where epileptic activity starts would not cause damage or disability. If successful, there is a chance your epilepsy will be cured.

If surgery is not an option, an alternative may be to implant a small device under the skin of the chest. The device sends electrical messages to the brain. This is called vagus nerve stimulation (see below).

Sometimes, a special diet is used for children whose seizures are difficult to control and do not respond to drug treatment.

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Anti-epileptic drugs (AEDs) show

Most people with epilepsy can be successfully treated with medicines known as anti-epileptic drugs (AEDs). AEDs do not cure epilepsy, but can prevent seizures from occurring.

There are many different AEDs. Generally, they work by changing the levels of the chemicals in your brain that conduct electrical impulses. This reduces the chance of a seizure.

The drugs used to treat epilepsy are often referred to as first-line and second-line drugs. This does not mean that one type of drug is better than the other, but it refers to when the drugs were first introduced. First-line drugs are older and have treated epilepsy for decades. Second-line drugs are much newer.

The type of drug prescribed depends largely on the kind of seizures that you have.

The older first-line AEDs include sodium valproate, carbamazepinephenytoin and phenobarbital.

Newer second-line AEDs are recommended if there is a reason why you cannot take AEDs, if there is concern about an older AED interacting with other drugs (such as the contraceptive pill), or if you are thinking of having a baby.

Newer AEDs include gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabinetopamax and vigabatrin. Levetiracetam is not recommended for children, but the others are recommended if older AEDs do not benefit children with epilepsy.

Your specialist will start you on a low dose of the AED, then gradually increase it within safe limits until your seizures stop. If one AED does not control seizures, another will be tried by gradually introducing the new drug and slowly reducing the dose of the old drug.

The aim is to achieve maximum seizure control with minimum side effects, using the lowest possible dose of a single drug. Trying a different type of AED is preferable to taking more than one AED, although a combination of drugs may be necessary to control seizures.

Follow your specialist's advice as switching brands or formulations could lead to seizures.

Side effects are common when starting treatment with AEDs. However, they are short term and usually pass in a few days. Side effects include:

  • nausea
  • abdominal pain
  • drowsiness
  • dizziness
  • irritability
  • mood changes

Some side effects, which produce symptoms similar to being drunk, occur when the dose of AEDs is too high. They include:

  • unsteadiness
  • poor concentration
  • drowsiness
  • vomiting
  • double vision

If you experience any of these symptoms, contact your GP or epilepsy specialist immediately so that your dosage can be revised.

It is important you follow any advice about when to take AEDs and how much to take. Never suddenly stop taking an AED because doing so could cause a seizure.

While taking AEDs, do not take any other medicines, including over-the-counter medicines or complementary medicines such as St John's Wort, without first speaking to your GP or epilepsy specialist. Other medicines could have a dangerous interaction with your AEDs and cause a seizure.

If you do not have a seizure for more than two years, it may be possible to stop taking your AEDs. Your epilepsy specialist can discuss with you the best way to safely stop taking your AEDs.

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Vagus nerve stimulation (VNS) show

If, after you have tried various types of AED, your epilepsy is still poorly controlled, vagus nerve stimulation (VNS) therapy may be recommend. This involves surgically implanting a small electrical device, similar to a pacemaker, under your skin, near your collarbone.

The device has a lead that is wrapped around one of the nerves in the left side of your neck, known as the vagus nerve. The device passes a regular dose of electricity to the nerve to stimulate it. This can help reduce the frequency and severity of seizures.

If you feel the warning sign of a seizure coming on, you can activate an extra ‘burst’ of stimulation, which can often prevent the seizure from occurring.

How and why VNS works is not fully understood, but it is thought that stimulating the vagus nerve alters the chemical transmissions in the brain.

Most people who undergo VNS still need to take AEDs.

Some mild to moderate side effects of VNS have been reported, including:

  • temporary hoarseness and a change in voice tone when the device is being used (this normally occurs every five minutes and lasts for 30 seconds)
  • sore throat
  • shortness of breath
  • coughing

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Ketogenic diet show

A ketogenic diet was one of the treatments used before AEDs were available, but is no longer recommended for adults with epilepsy. A ketogenic diet is high in fats and low in carbohydrates and protein, and may make seizures less likely by altering the chemical composition of the brain. However, a high-fat diet is linked to serious health conditions, such as diabetes and cardiovascular disease, so is not generally recommended.

A ketogenic diet is sometimes advised for children with seizures that are difficult to control and have not responded to AEDs. The diet has been shown to reduce the number of seizures in some children. It should only be used under the supervision of an epilepsy specialist with the help of a dietitian.

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Surgery show

If your epilepsy is still poorly controlled after two years of treatment, you may be referred to a specialist epilepsy centre to see if you are suitable for brain surgery.

This involves having various types of brain scans to find out where the epilepsy is focused. Memory and psychological tests are also conducted to gauge how you are likely to cope with the stress of surgery and how it might affect you.

Surgery is only recommended when:

  • A single area of only one side of the brain is causing seizures.
  • Removing that part of the brain would not cause any significant loss of brain function.

As with all types of surgery, this procedure carries a risk. About 1 in 100 patients has a stroke after surgery, and about 5 in 100 experience memory problems. However, around 70% of people who have epilepsy surgery become completely free of seizures.

Before having the procedure, your surgeon will explain to you the benefits and risks of the surgery.

Most people normally recover from the effects of surgery after a few days, but it could be two to three months before you are fully fit and able to return to work.

Deep brain stimulation (DBS) therapy is also a surgical treatment for epilepsy. It is used to treat people with epilepsy that is difficult to control or cannot have a part of their brain removed.

DBS involves implanting electrodes into specific areas of the brain to control seizures. The electrodes are controlled by an external device called a neurostimulator.

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Complementary therapies show

There are several complementary therapies that some people say work for them. However, none has been shown conclusively in a study to reduce seizures. Withdrawing anti-epileptic medication without medical specialist supervision may result in seizures. Treat with caution any advice from therapists to reduce or stop taking your anti-epileptic medication.

Herbal remedies should be used cautiously because some of their ingredients can interact with anti-epilepsy drugs. St John’s Wort, a herbal remedy used for mild depression, is not recommended for people with epilepsy because it can affect the blood levels of anti-epilepsy drugs and may affect seizure control. Ayurvedic herbal medicines are also not recommended.

For some people with epilepsy, stress can trigger seizures. Stress-relieving and relaxation therapies such as exercise, yoga and meditation may help.

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Page last reviewed: 06/09/2012

Next review due: 06/09/2014

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Even small changes to your medicine can affect your epilepsy

If you take prescribed tablets for epilepsy:

  • • Take them as your doctor prescribed them.
  • • Do not change your dose without talking to your doctor.
  • • Do not suddenly stop taking your tablets.

Ask a doctor, nurse or pharmacist if you have been given new or different tablets. A different make of tablet may affect your epilepsy.

What to do if you see a seizure

Make sure you know what to do if you see someone having a seizure (fit), whether caused by epilepsy or not

Preparing for surgery

What you need to organise in the days leading up to your operation