What are the treatments for epilepsy?

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Medication

Epilepsy cannot be 'cured' with medication. However, various medicines can prevent seizures. They work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures. Seizures are well controlled by medication in about 4 out of 5 cases. Deciding on which medicine to prescribe depends on such things as: the type of epilepsy, age, other medicines that you may take for other conditions, possible side-effects, pregnancy, etc.

One medicine can prevent seizures in most cases. A low dose is usually started at first. The dose may be increased if this fails to prevent seizures. In some cases two medicines are needed to prevent seizures.

The decision when to start medication may be difficult. A first seizure may not mean that you have epilepsy as a second seizure may never happen, or occur years later. The decision to start medication should be made by weighing up all the pros and cons of starting, or not starting, the medicine. A common option is to 'wait and see' after a first seizure. If you have a second seizure within a few months, more are likely. Medication is commonly started after a second seizure that occurs within 12 months of the first. However, there are no definite rules and the decision to start medication should be made after a full discussion with your doctor.

Some points about medication for epilepsy include the following:

Ask your doctor how long treatment is likely to be advised. This will vary from case to case. If you have not had seizures for several years, you may wish to try stopping medication. But this depends on your particular type of epilepsy. There are many different types of epilepsy, some of which are age dependent, but some that will need medication for life. Your life circumstances may influence the decision about stopping medication. For example, if you have recently regained your driving licence, the risk of losing it again for a year if a seizure occurs may affect your decision. However, if you are a teenager who has been free of seizures for some years, you may be happy to take the risk.
Although the list of possible side-effects for each medicine seems long, in practice, most people have few or no side-effects, or just minor ones. Ask your doctor which side-effects are important to look out for. If you develop a troublesome side-effect it may be dose-related, or may diminish in time. Alternatively, a switch to another medicine may be advised.
Medicines which are used for other conditions may interfere with medication for epilepsy. If you are prescribed or buy another medicine, remind your doctor or pharmacist that you take medication for epilepsy. Even things like indigestion medicines may interact with your epilepsy medication which may increase your chance of having a seizure.
Some medicines for epilepsy interfere with the contraceptive pill. A higher dose pill may be needed for effective contraception.
Tell your doctor if you intend to become pregnant. Pre-conception counselling is important for women with epilepsy.
If you have epilepsy, you are exempt from prescription charges for all your prescriptions. You need an exemption certificate. You can get this from your pharmacist or by contacting the Prescription Helpline: 0845 601 8076.

Other treatments

Surgery to remove a cause of seizures in the brain is an option in a small number of cases. It may be considered when medication fails to prevent seizures. It is only possible for certain causes in certain areas of the brain. So, only a small number of people are suitable for surgery. Also, there is risk involved in brain surgery. However, techniques continue to improve and surgery may become an option for more and more people in the future.
Vagal Nerve Stimulation is an option for some people
The Ketogenic diet, a diet that needs to be supervised by an experienced dietician, is useful for some children and adults with particular types of epilepsy.
Complementary therapies such as aromatherapy may help with relaxation and relieve stress, but have no proven effect on preventing seizures.

By Rob Mansfield

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