There is at present no cure for epilepsy, although some people with epilepsy may go into remission — meaning all symptoms of the condition disappear. The good news is that although epilepsy is not yet curable, it is treatable for most people.

There is a wide range of epilepsy treatments, with most falling into one or more of five broad categories:

• Medication
• Diet
• Implanted devices
• Surgeries
• Natural and alternative treatments

Before recommending a course of treatment, a physician will take into account a person’s age, overall health, medical history, severity of the condition, and type or types of seizures. The goal of epilepsy treatment is to stop seizures — or to at least decrease their frequency as much as possible.

There isn’t one treatment that works for all types of seizures and types of epilepsy. Some epilepsies and seizure types are more difficult to treat because they don’t respond well to most treatments.

What Is the Most Common Treatment for Epilepsy?

Medication is usually the first treatment prescribed for epilepsy. On average, anti-seizure medications (ASMs) — also called antiepileptic drugs or anticonvulsants — will work for 60 percent to 70 percent of people with epilepsy and are the most common epilepsy treatment.

However, in as many as 20 percent to 40 percent of epilepsy cases, seizures can’t be adequately controlled with any type of anticonvulsant medication. Drug-resistant epilepsy is also known as intractable or refractory epilepsy. If ASMs are ineffective, doctors may recommend a special diet, an implanted device, or surgery.

Here are the five key categories of epilepsy treatment.

1. Anti-Seizure Medication for Epilepsy

ASMs work in different ways, but they are all believed to reduce excess electrical activity in the brain. There is an increasing number of ASMs on the market, and many of the newer medications offer more focused treatment with fewer serious side effects.

Most ASMs are taken by mouth — some are designed to dissolve in the mouth instead of being swallowed. Other treatments are given rectally or as an injection. ASMs that can be administered as a nasal spray are under development.

If you’ve been prescribed a medication that’s ineffective at controlling your seizures, or if its side effects are bothering you, contact your doctor. Finding the right medication and the right dosage can be a long process. In cases where ASMs aren’t working, your doctor may recommend dietary changes or surgery.

Narrow-Spectrum ASMs

Narrow-spectrum ASMs treat specific types of seizures, such as absence seizures or focal seizures. Drugs in this category include:

• Brivaracetam (Briviact)
• Carbamazepine (sold as Tegretol and Carbatrol)
• Gabapentin (Neurontin)
• Lacosamide (Vimpat)
• Oxcarbazepine (Trileptal)
• Phenytoin (Dilantin)
• Pregabalin (Lyrica)

Broad-Spectrum ASMs

Broad-spectrum ASMs can be effective for multiple seizure types. Broad-spectrum anticonvulsants include:

• Cenobamate (Xcopri)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Rufinamide (Banzel)
• Topiramate (Topamax)
• Valproic acid (Depakote)
• Zonisamide (Zonegran)

Apart from ASMs, other classes of drugs may be prescribed to control seizures. For instance, clonazepam (Klonopin) is a sedative of the benzodiazepine class used to treat myoclonic seizures and Lennox-Gastaut syndrome, a severe form of epilepsy. Phenobarbital is a barbiturate (a class of drugs that depress the central nervous system).

All ASMs have side effects, especially during the first few weeks of treatment. Common side effects of ASMs include:

• Drowsiness
• Dizziness
• Increase or decrease in appetite
• Mood changes
• Problems with memory or attention
• Vision changes

All ASMs are required by the U.S. Food and Drug Administration (FDA) to carry a suicide warning. The risk for suicide due to ASMs is quite low, but anyone taking an ASM should be aware of and report any serious depression or suicidal thoughts to their doctor.

Some ASMs, like phenytoin, carbamazepine, primidone, oxcarbazepine, and topiramate, often cause drug interactions. They can interfere with anticoagulant medications such as warfarin, oral contraceptives, cancer treatments, and drugs for infections. Also, birth control pills can interfere with the effectiveness of ASMs. Certain ASMs are also known to have a higher risk of birth defects if either birth parent is taking them.

Never change your dose or stop your medication without consulting with your doctor. Withdrawal must be done under close supervision. Suddenly stopping a medication can cause more severe seizures.

2. Diet for Epilepsy

For drug-resistant epilepsy, doctors may recommend adopting a specific diet to help control seizures. Research shows that in combination with ASMs, a diet high in fat and low in carbohydrates can help some people control their epilepsy.

The ketogenic diet, used to treat children with refractory epilepsy, is an extreme diet involving fasting and is monitored by a physician and a nutritionist. The purpose of the diet is to force the body to burn fat for energy instead of carbohydrates, increasing the level of molecules called ketones in the blood. A ketogenic diet can act similarly in the brain as ASMs. For some children, a high level of ketones reduces seizure activity.

For adults, a less extreme version of the ketogenic diet is the modified Atkins diet. This diet is mainly for people who have frequent seizures and haven’t found relief from medications.

Diet changes should be made with your doctor’s knowledge and guidance.

3. Implanted Devices for Epilepsy

Some people with intractable epilepsy may be candidates for an implanted device such as a vagus nerve stimulator (VNS), a responsive neurostimulation system (RNS), or a neurostimulator for deep brain stimulation (DBS). A person’s eligibility for these devices varies by age. These devices are palliative options — meaning they are intended to provide symptom relief — for those who have tried several ASMs.

Vagus Nerve Stimulation

A vagus nerve stimulator is a device similar to a pacemaker that is implanted under the skin near the collarbone. The device uses a lead, or thin wire, to connect to the vagus nerve in the neck. It then stimulates the nerve at regular intervals, which can reduce the intensity and frequency of seizures. VNS may be more effective in treating focal seizures than other types of seizures.

Newer vagus nerve stimulators, including AspireSR, can predict some seizures by detecting a rapid increase in your heart rate. They respond with stimulation that sometimes stops the seizure from happening.

Responsive Neurostimulation System

A responsive neurostimulation system may also be used to treat epilepsy. This system is a small, electronic device that is implanted inside the skull. One or two thin wires from the device are connected to the seizure targets. The device is then programmed to detect and record brain activity patterns and respond with electrical stimulation when abnormal patterns are detected. Stimulation cannot be felt. Once you have this device implanted, you will receive a brain-activity monitor that will record data and send it to the neurologist.

People generally continue taking ASMs after receiving an implanted device.

Deep Brain Stimulation

DBS is a novel way of controlling seizures. It entails implanting an electrode in a specific area of the brain called the thalamus. The electrodes then deliver electrical impulses to regulate abnormal impulses or to affect certain brain cells and chemicals. This, in turn, can reduce the frequency of seizures. DBS is approved for use in people ages 18 and older with drug-resistant epilepsy.

4. Epilepsy Surgery

Surgical treatment may be recommended for people whose seizures are severe or frequent enough to be life-threatening or significantly impact quality of life. Candidates for epilepsy surgery must have failed several epilepsy drugs and have seizures with a known focus. Epilepsy surgeries fall into two general categories: resection and disconnection.

Resection Surgery

The most common type of neurosurgery for epilepsy is resection, in which the portion of the brain causing seizures is removed. If successful, the surgery can provide long-term remission from seizures. Names of resection procedures often end in “-ectomy,” which means “removal by cutting.”

Temporal lobectomy, also known as temporal lobe resection, is the most frequently performed of all epilepsy surgeries and has the highest success rate. However, there are several other types of resection surgeries.

Disconnection Surgery

Disconnection surgeries attempt to limit the spread of seizure activity and reduce seizure frequency. Disconnection surgeries are known as palliative treatments because they can improve quality of life, but they do not cure epilepsy.

The most common type of disconnection surgery is the corpus callosotomy, in which the fibers connecting the two hemispheres, or sides of the brain, are severed to stop seizures from spreading between them. Corpus callosotomy surgery is usually performed on children who have debilitating seizures that cause injuries and falls. Multiple subpial transection is another surgery designed to disconnect the seizure focus, limiting the spread of seizures.

A functional hemispherectomy combines the resection of a seizure focus in one hemisphere with corpus callosotomy.

Learn more about evaluating your options for epilepsy surgery.

5. Natural and Alternative Treatments for Epilepsy

Some people with epilepsy try natural or alternative treatments. If you’re interested in any of these options, talk with your doctor to make sure they don’t interfere with your ASMs.

Some people with epilepsy have reported improvements when they use complementary therapies such as acupuncture, herbal or nutritional supplements, chiropractic treatments, and meditation.

Some people report improvements in their epilepsy when using medical cannabis (marijuana). Epidiolex is the first cannabidiol (CBD) medication approved by the FDA to treat certain epilepsy syndromes, including Lennox-Gastaut syndrome and Dravet syndrome.

Some people also use melatonin to reduce the severity of seizures from epilepsy. However, there isn’t much evidence to support melatonin for treating epilepsy, and more research is needed.

What Are the Do’s and Don’ts of Epilepsy?

You can take a few other steps to get the most from your epilepsy treatments. There are also behaviors to avoid that might worsen seizures. These are some basic do’s and don’ts of living with epilepsy.

Do:

• Get enough sleep.
• Minimize stress in your life.
• Drink lots of water.
• Protect yourself from colds and other contagious illnesses.

Don’t:

• Drink alcohol.
• Use recreational drugs.
• Miss medication doses.
• Skip meals.

Be sure to consult your doctor before taking new medications, as some can worsen epilepsy seizures.

Building a Community

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Have you tried any of these epilepsy treatment options? Do you have any advice for others? Share your experience in the comments below, or start a conversation by posting on MyEpilepsyTeam.