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5 Epilepsy Treatment Options: Surgery and More

Medically reviewed by Chiara Rocchi, M.D.
Updated on October 29, 2024

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:

Broad-Spectrum ASMs

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

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.

What Makes Someone a Good Candidate for Epilepsy Surgery?

Transcript

00:00:00:00 - 00:00:18:02
Mary Ray
We've gotten a few questions about surgical treatments for epilepsy and Désirée asks, "How would someone know if they might be a candidate for surgery to treat epilepsy?"

00:00:18:02 - 00:00:31:02
Dr. Edwards
Désirée, that's an excellent, excellent question, and the answer is, I wouldn't expect you to just know on your own, but you should feel empowered to ask. Okay, you should be empowered to ask,

00:00:31:04 - 00:00:58:16
Dr. Edwards
and if the first two to three, max, medicines, haven't gotten your seizures under good control, you should be seen at an epilepsy center. If the first two to three drugs don't work, we're probably dealing with refractory epilepsy and which by definition means the medications probably aren't going to get you seizure free, so you need to look into things other than medications.

Mary Ray
Like surgery.

Dr. Edwards
Like surgery.

00:00:58:17 - 00:01:25:08
Dr. Edwards
Now why is it that epilepsy specialists talk about surgery so much? And the answer, quite simply, is because it is by far the most effective treatment for medication refractory epilepsy, right? So the question, once a couple of medications have failed, you have to say, okay, what are my real treatment options here? And you look at surgery versus not doing surgery.

00:01:25:10 - 00:01:55:15
Dr. Edwards
If you don't, if surgery is not an option, the chances of seizure freedom with medication is somewhere between 5% and 10%. With surgery, it's about 70%. Okay, so not a hundred, but it's not 5 to 10. And additionally, people worry about the safety of surgery. Well, you know, the old expression, well it's not brain surgery, you know? Well, epilepsy surgery is brain surgery, but it's very, very safe,

00:01:55:17 - 00:02:11:11
Dr. Edwards
and in fact, epilepsy surgery is much safer than continuing to live with uncontrolled seizures.

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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

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

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.

References
  1. Will You Always Have Seizures? — Epilepsy Foundation
  2. Remission in Epilepsy: How Long Is Enough? — Epilepsia
  3. Treatments for Epilepsy — Mount Sinai
  4. Treating Patients With Medically Resistant Epilepsy — Neurology Clinical Practice
  5. Initial Response to Antiepileptic Drugs in Patients With Newly Diagnosed Epilepsy as a Predictor of Long-Term Outcome — Frontiers in Neurology
  6. Epilepsy Treatment — NHS
  7. Drug Resistant Epilepsy — Epilepsy Foundation
  8. Mechanisms of Action of Antiseizure Drugs and the Ketogenic Diet — Cold Spring Harbor Perspectives in Medicine
  9. Summary of Anti-Seizure Medications — Epilepsy Foundation
  10. Cenobamate for the Treatment of Focal Epilepsy — Drugs Today
  11. Adverse Effects of Antiepileptic Drugs — The Lancet Neurology
  12. Suicide-Related Events in Patients Treated With Antiepileptic Drugs — The New England Journal of Medicine
  13. Specific Birth Defects Following Antiseizure Medications Used By Pregnant Women With Epilepsy — Neurology Clinical Practice
  14. Differential Impact of Antiepileptic Drugs on the Effects of Contraceptive Methods on Seizures: Interim Findings of the Epilepsy Birth Control Registry — Seizure
  15. Ketogenic Diet and Epilepsy: What We Know So Far — Frontiers in Neuroscience
  16. Modified Atkins Diet — Epilepsy Foundation
  17. Vagus Nerve Stimulation for the Treatment of Epilepsy — Neurosurgery Clinics of North America
  18. Vagus Nerve Stimulation for Focal Seizures — Cochrane Library
  19. Brain-Responsive Neurostimulation for Epilepsy (RNS System) — Epilepsy Research
  20. Deep Brain Stimulation — Mayo Clinic
  21. Epilepsy Surgery — StatPearls
  22. Report of a Parent Survey of Cannabidiol-Enriched Cannabis Use in Pediatric Treatment-Resistant Epilepsy — Epilepsy & Behavior
  23. Epidiolex (Cannabidiol) Primer: Frequently Asked Questions for Patients and Caregivers — The Journal of Pediatric Pharmacology and Therapeutics
  24. Melatonin as an Add-On Treatment for Epilepsy: A Systematic Review and Meta-Analysis — Seizure European Journal of Epilepsy
  25. Tips & Tricks for People Living With Epilepsy — Epilepsy Foundation
Updated on October 29, 2024

A MyEpilepsyTeam Member

I wish I had this article in 1969 lol 💜

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Chiara Rocchi, M.D. completed medical school and neurology residency at Polytechnic Marche University in Italy. Learn more about her here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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