Epilepsy Treatment
Can epilepsy be cured permanently?
How do you treat seizures?
What are the main causes of epilepsy?
What foods are good for epilepsy?
What is the most common type of epilepsy?
What are the three types of epilepsy?
The goal of treatment in patients with epileptic seizures is to achieve a seizure-free status without adverse effects. This goal is accomplished in more than 60% of patients who require treatment with anticonvulsants. Many patients experience adverse effects from these drugs, however, and some patients have seizures that are refractory to medical therapy. A 2017 study found that fewer than two thirds of patients with newly diagnosed epilepsy are seizure-free after 1 year. A smaller study published in 2000 found the seizure-free rate to be 64%, which is almost identical to the rate found in the newer study.
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Epilepsy treatments
- Lifestyle changes and complementary or alternative treatments
Your neurologist should address these questions with you before developing a treatment plan:
- How is your sleep quality?
- Do you have chronic anxiety, depression, or excessive stress?
- Do you take other medications that may affect your epilepsy medication or directly increase the risk you will have a seizure?
- Does your use of alcohol, caffeine, or herbal remedies affect your seizure control?
The complementary and alternative therapies below can be added to your treatment plan. Because there is not a lot of medical research on their effectiveness for epilepsy, it’s important to discuss each treatment with your neurologist:
- Acupuncture
- Aerobic exercise
- Biofeedback (training to voluntarily control seizures)
- Meditation
- Yoga
- Diet
For many years, a special diet has been used to control certain types of epilepsy. One in particular – the ketogenic diet – gained public attention with the 1997 movie “First Do No Harm.” In this film, which is based on a true story, Meryl Streep plays the mother of a son whose epilepsy fails to respond to conventional treatments, including epilepsy surgery. She takes him to Johns Hopkins Medical Center, which pioneered the use of the ketogenic diet and demonstrated its effectiveness. Her son responded wonderfully to the diet and became seizure-free.
- FDA-approved medications
Medications that have been tested in rigorous scientific trials and gotten approval from the U.S. Food and Drug Administration (FDA) are the mainstay of epilepsy treatment. But before we start a medication, we have to make sure a person truly has epilepsy. Up to 10 percent of people have an epileptic seizure during their life. However, they do not necessarily have epilepsy. For example, a person might have a seizure due to taking a certain drug. That would be a one-time event and would not represent epilepsy. Epilepsy is a neurologic disorder that causes unexpected and recurrent epileptic seizures.
- Medication trials
At any time, a patient may be invited to participate in a trial of an experimental medication. Since about 1993, this is how all medications have received FDA approval. Often, patients are invited to join a trial after they have failed a number of other FDA-approved medications.
The advantages of participating in a clinical trial include:
- Access to new medication
- Close support and follow-up with the epilepsy team
- The opportunity to help medical researchers develop new treatments
5 Extra cranial neurostimulators
Neurostimulators deliver electrical stimulation to the brain. Some stimulate nerves that are not in the brain, which then transfer the electrical stimulation to the brain; we refer to these as extra cranial stimulators.
The first and most common stimulation of this type is the vagus nerve stimulation (VNS), in which an electrode is wrapped around the vagus nerve on the left side of the neck and a computer battery is implanted under the skin below the collar bone. We start with the stimulator set to deliver a 30-second electrical impulse every five minutes. Each patient has a magnet that activates the device immediately and at a higher intensity if a seizure occurs. Newer versions of the VNS also can trigger a stimulus when the patient’s heartbeat goes too fast, which often happens with an epileptic seizure.
6. Extra cranial neurostimulators
Treatment options include:
- High-dose steroids
- Administering a collection of human antibodies through the veins
- Plasma exchange to filter the blood of disease-causing antibodies
- Other medications that suppress the overly active immune system
How about Herbal treatments
With an increasing market and public interest, herbal treatments have soared in popularity. There seems to be an herb for every ailment.
Some of the most commonly used herbs for epilepsy are:
- burning bush
- groundsel
- hydrocotyle
- lily of the valley
- mistletoe
- mugwort
- peony
- scullcap
- tree of heaven
- valerian
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Can epilepsy be cured permanently?
There’s no cure for epilepsy, but early treatment can make a big difference.
Uncontrolled or prolonged seizures can lead to brain damage. Epilepsy also raises the risk of sudden unexplained death.
The condition can be successfully managed. Seizures can generally be controlled with medication. Although there’s no cure at this time, the right treatment can result in dramatic improvement in your condition and your quality of life.
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How do you treat seizures?
Treatment can help most people with epilepsy have fewer seizures, or stop having seizures completely.
Treatments include:
- medicines called anti-epileptic drugs (AEDs)
- surgery to remove a small part of the brain that's causing the seizures
- a procedure to put a small electrical device inside the body that can help control seizures
- a special diet (ketogenic diet) that can help control seizures
Some people need treatment for life. But you might be able to stop if your seizures disappear over time.
You may not need any treatment if you know your seizure triggers and are able to avoid them.
Many medications are used in the treatment of epilepsy and seizures, including:
- Carbamazepine (Carbatrol, Tegretol, others)
- Phenytoin (Dilantin, Phenytek)
- Valproic acid (Depakene)
- Oxcarbazepine (Oxtellar, Trileptal)
- Lamotrigine (Lamictal)
- Gabapentin (Gralise, Neurontin)
- Topiramate (Topamax)
- Phenobarbital
- Zonisamide (Zonegran)
Finding the right medication and dosage can be challenging. Your doctor likely will first prescribe a single drug at a relatively low dosage, and then increase the dosage gradually until your seizures are well-controlled.
Many people with epilepsy are able to prevent seizures with just one drug, but others need more than one. If you've tried two or more single-drug regimens without success, your doctor may recommend trying a combination of two drugs.
To achieve the best seizure control possible, take medications exactly as prescribed. Always call your doctor before adding other prescription medications, over-the-counter drugs or herbal remedies. And never stop taking your medication without talking to your doctor.
Mild side effects of anti-seizure medications can include:
- Fatigue
- Dizziness
- Weight gain
More-troubling side effects that need to be brought to your doctor's attention immediately include:
- Mood disruption
- Skin rashes
- Loss of coordination
- Speech problems
- Extreme fatigue
In addition, the drug Lamictal has been linked to an increased risk of aseptic meningitis, an inflammation of the protective membranes that cover the brain and spinal cord that's similar to bacterial meningitis.
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Surgery and other therapies
When anti-seizure medications aren't effective, other treatments may be an option:
- Surgery. The goal of surgery is to stop seizures from happening. Surgeons locate and remove the area of your brain where seizures begin. Surgery works best for people who have seizures that always originate in the same place in their brains.
- Vagus nerve stimulation. A device implanted underneath the skin of your chest stimulates the vagus nerve in your neck, sending signals to your brain that inhibit seizures. With vagus nerve stimulation, you may still need to take medication, but you may be able to lower the dose.
- Responsive neurostimulation. During responsive neurostimulation, a device implanted on the surface of your brain or within brain tissue can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure.
- Deep brain stimulation. Doctors implant electrodes within certain areas of your brain to produce electrical impulses that regulate abnormal brain activity. The electrodes attach to a pacemaker-like device placed under the skin of your chest, which controls the amount of stimulation produced.
- Dietary therapy. Following a diet that's high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, though less effective, aren't as restrictive as the ketogenic diet and may provide benefit.
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What are the main causes of epilepsy?
Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:
- Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence.
Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
- Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
- Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
- Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
- Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
- Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.
- Certain factors may increase your risk of epilepsy:
- Age. The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.
- Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
- Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
- Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly.
- Dementia. Dementia can increase the risk of epilepsy in older adults.
- Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk.
- Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won't develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.
What foods are good for epilepsy?
Although there is little evidence that a balanced diet has a direct effect on seizures, it provides essential nutrients and keeps our energy levels steady. A balanced diet may also help you to keep a regular sleep pattern and keep active, both of which are good for overall health. Getting enough sleep may help to reduce the risk of seizures for some people. A diet that suits you may help you to feel positive, more able to focus and more in control of your life and decisions about managing your epilepsy.
A balanced diet is generally made up of carbohydrates, fats, proteins, vegetables and fruit, and drinking plenty of fluids. Research continues into what makes a healthy diet, and dietary guidelines are also influenced by where we live, our health needs, and our lifestyle.
- Carbohydrates provide energy and are found in foods such as potatoes, bread, pasta and rice. Wholegrain versions of these foods provide extra vitamins, minerals and fibre (which helps to remove waste from the body).
- Fats can be found in oils, oily fish, nuts and seeds. Fats help us to absorb nutrients including some important vitamins, and keep us warm. They help keep our cells healthy and give us energy.
- Proteins build and support our muscles, hormones, enzymes, red blood cells and immune system. Protein is in dairy foods such as milk and cheese, and also in meat, fish, tofu, beans, lentils and eggs.
- Vegetables and fruit of various colors provide vitamins and minerals. They also help protect us from infection, damage to our cells and diseases. Currently it is recommended that we aim to eat at least five portions of vegetables or fruit per day (one portion is roughly a handful).
Cooked food is usually healthier when steamed, baked, grilled, poached or boiled, rather than fried.
Drinking water helps us to function and concentrate, and reduces the risk of seizures triggered by dehydration.
What is the most common type of epilepsy?
Temporal lobe seizures, a category of focal seizures, are the most common type of epilepsy.
What are the three types of epilepsy?
- All types of epilepsy have seizures as a symptom. These are surges of electricity in your brain. They're like electrical storms that briefly stop your brain cells from working normally.
- If you had a seizure caused by epilepsy, your doctor will follow three steps to give you the right diagnosis.
- Figure out the types of seizures you had
- Based on the type of seizure, figure out the type of epilepsy you have
- Decide whether you have a specific epilepsy syndrome as well
Experts now divide epilepsy into four basic types based on the seizures you're having:
- Generalized epilepsy
- Focal epilepsy
- Generalized and focal epilepsy
- Unknown if generalized or focal epilepsy
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