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How Is Epilepsy Treated?
Doctors usually treat epilepsy with medication. Seizures are controllable by medication in about 70% of cases. If medications don’t stop the seizures, the doctor may propose surgery or another type of treatment. Dietary changes are often tried for childhood epilepsy.
The U.S. Food and Drug Administration (FDA) has approved several prescription drugs to treat epilepsy.
Most people with epilepsy can become seizure-free by taking a single anti-seizure medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.
Starting anti-seizure medication therapy reduces the risk of another seizure. The doctor will schedule ongoing follow-up appointments to evaluate how the medications are working.
Finding the right medication and dosage can be complicated. The doctor will consider a patient’s age and overall health, how often seizures occur, and other factors when prescribing a medication. Some people with epilepsy may be able to go off medications if they have gone two or more years without seizures — with the advice and support of their doctor.
Anti-seizure medications may have side-effects, such as:
- Weight gain
- Loss of bone density
- Skin Rashes
- Loss of coordination
- Speech problems
- Memory and thinking problems
More severe, but rare, side-effects include:
- Suicidal thoughts and behaviors
- Severe rash
- Inflammation of certain organs, including the liver
If medications don’t control seizures, surgery may help. During epilepsy surgery, a surgeon removes the area of the brain where seizures begin.
Doctors usually perform surgery when tests show that seizures originate in a small, well-defined area of the brain that doesn’t interfere with crucial functions such as speech, language, motor function, vision, or hearing.
Although many people still need medication to help prevent seizures after successful surgery, they may be able to lower the dose.
In addition to medications and surgery, additional therapies offer options for epilepsy:
- Ketogenic diet. Some children with epilepsy are able to reduce seizures by following a strict diet that’s high in fats and low in carbohydrates. The “ketogenic” diet allows the body to use fat, rather than carbohydrates, for energy. After a few years, some children may be able to stop the ketogenic diet and remain seizure-free.
A ketogenic diet must be strictly monitored and prescribed by a doctor. A registered dietitian (RD) can help families manage their diet. Side-effects of a ketogenic diet include dehydration, constipation, slowed growth due to nutritional deficiencies, and kidney stones. These side-effects are rare if the diet is medically supervised.
- Vagus nerve stimulation can often reduce seizures by 20-40%. The doctor implants a device called a vagus nerve stimulator underneath the skin of the chest. It’s similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in the neck. The battery-powered device sends bursts of electrical energy through the vagus nerve to the brain. Potential side-effects from vagus nerve stimulation include throat pain, hoarse voice, shortness of breath, or coughing. After vagus nerve stimulation, people often still need to take anti-seizure medication, though they may be able to lower the dose.
- Deep brain stimulation. Surgeons implant electrodes into a specific part of the brain, typically the thalamus. Similar to vagus nerve stimulation, the electrodes are connected to a generator implanted in the chest or skull. The device sends electrical pulses to the brain, which may reduce seizures. Deep brain stimulation may help relieve symptoms. People may need to take anti-seizure medication, though they may be able to lower the dose.
- Avoidance therapy. Some people experience seizures as a reaction to specific stimuli, like certain sounds or flashing lights. Avoidance therapy focuses on minimizing or eliminating triggers. For example, those who are sensitive to light may benefit from using a small television, avoiding video games, or wearing dark glasses. Avoidance does not replace medicine.
- Exercise. Exercise has been proposed as potentially useful for preventing seizures.
- Therapy animals. Some dogs, often referred to as seizure dogs, may help during or after a seizure. It is not clear whether dogs can predict seizures before they occur.
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