There is no cure for epilepsy, however the majority of people can achieve good seizure control with the right treatment.  Many people will become seizure free once they have started treatment. 

Anti-epileptic drugs are usually the first treatment of choice.  Other treatment options include surgery, device based or dietary treatment options, but they may not always be suitable for everyone.  There is no single treatment that works for everybody.

The following explores some of the possible treatment options.

Anti-epileptic drugs

This is the most common treatment for epilepsy.  Anti-epileptic drugs (AEDs) work by preventing seizures from happening.  Between 50-70% of people can become seizure free with the right medication.

Like all other prescribed medications, AEDs can have side effects.  These commonly include tiredness, lethargy, drowsiness and wait gain or loss.  In many cases, side effects are mild and tend to fade once the body has become used to the medication.

You should discuss any concerns you may have about certain side effects with your doctor or epilepsy specialist nurse.  They may suggest adjusting the dosage or switching you to a different AED.

 

Never stop taking your AEDs unless advised by your medical team.

 

Some AEDs can interact with the contraceptive pill or should be avoided during pregnancy.  If you are planning to start a family always seek medical advice before you get pregnant.

Never stop your medication without medical advice even if you have an unplanned pregnancy, as this could put you or your unborn baby at risk.

There is more information on AEDs in the following publications:

Emergency medication

Most seizures are short, will stop on their own and do not require any medical intervention.  Seizures can become a medical emergency if the seizure lasts two minutes longer than usual, or five minutes in total as a general guidance. 

A medical emergency can also arise if a person has one seizure after another without full recovery in between.  Full recovery means return to full consciousness and normal breathing.

A prolonged seizure can lead to status epilepticus.  This is defined as a seizure which does not stop on its own.  Status epilepticus is always a medical emergency and requires medical intervention.  It is more likely to happen if you have uncontrolled seizures.  

Emergency medication may be prescribed for anyone who has had a prolonged seizure.  It can stop a prolonged seizure or serial seizures, and should be administered long before a medical emergency arises to prevent the person going into status epilepticus.

You can find out more about this in our Emergency medication publication.

Surgery

Surgery is usually only an option for a small number of people.  Suitability will depend on several factors such as the cause of the epilepsy and type of seizures. However, once deemed suitable, there is often a high success rate with surgery, and it can result in full seizure control or at least a significant reduction in seizures.

People are usually only considered for surgery when a number of AEDs have been tried without controlling their seizures.  The process to assess suitability for surgery can be lengthy and involves detailed tests.  This will minimise the risk of surgery affecting important functions like memory or speech.  As with all surgery, there are risks and a successful outcome is not guaranteed.

If you are deemed suitable for surgery, you will have plenty of opportunities to discuss all of this with your epilepsy specialist and neurosurgeon.

To find out more about surgery, read our Epilepsy surgery publication.

Vagus Nerve Stimulation

Some people with epilepsy may be able to reduce frequency or severity of their seizures using a vagus nerve stimulation device (VNS). 

VNS does not usually replace treatment with AEDs, most people on VNS will continue to take their medication.  The VNS device is roughly the size of a pacemaker and is inserted under the left collar bone under general anaesthetic. 

A tiny wire under the skin connects the generator to the left vagus nerve in the neck.  It transmits regular electrical impulses from the generator via the vagus nerve to the brain.  This can help stop or reduce frequency or severity of seizures. 

It can also detect an increase in heart rate, which is usually a precursor of a seizure, and can deliver an additional dose of electrical impulses to try and stop the seizure.

To find out more about VNS, read our Device based treatment options publication.

Dietary treatment options

The most commonly known option is the ketogenic diet.  This prescription-only diet can sometimes be an alternative when children and adults do not respond to drug treatment.  The diet can be successful for some people by reducing the frequency and severity of seizures or by completely controlling them.  For others it will have no effect and seizures will continue. 

The ketogenic diet is primarily used for children, but a modified version of this diet is also available for adults.  Some adults also follow a modified Atkins diet which is a similar prescription only diet.

To find out more about this, for treatment for adults, read our Dietary treatments for adults publication, and for children, read our Ketogenic diet (for children) publication. 

Complementary therapies

There is a lot more to managing epilepsy than just seizure control.  A good quality of life is important, and this is where complementary therapies can sometimes be effective.

Complementary therapies are not an alternative to drug treatments You should never stop taking your medication. 

For many people, stress, anxiety or lack of sleep can be a trigger for their seizures.  Using complementary therapies to address these triggers for seizures can have a positive impact on a person’s overall wellbeing and could potentially help reduce the number of seizures.

A reputable and qualified complementary therapist will never claim to be able to cure your epilepsy or ask you to stop taking your medication.

To find out more about this, read our Complementary therapies publication.

Cannabis based medication

Cannabis for medicinal use is never far away from the news, however, reporting in the media has not always been accurate, often creating more confusion and misunderstanding around medical cannabis.

Cannabis based medicinal products, including those that contain the psychoactive compound tetrahydrocannabinol (THC), can now be prescribed by NHS Scotland in limited circumstances.

Clinical guidelines currently only recommend prescribing cannabis based medicines for three health conditions, i.e. two severe epilepsy syndromes, severe nausea caused by chemotherapy treatment, and MS-related muscle spasticity.

There is currently only one cannabis based medicine licensed for use within NHS Scotland to treat epilepsy.  This can only be prescribed by a specialist doctor, and only if it meets an exceptional clinical need.

Never stop your or your child’s anti-epileptic drugs without medical advice and supervision, as this could trigger a major seizure putting you or your child at risk.  Never substitute your or your child’s anti-epileptic medication with non-prescribed cannabis products unless advised by a specialist.

For more detailed information, read our Cannabis and epilepsy publication.

Self-management

The unpredictability of seizures can sometimes leave you feeling out of control.  You can, however, take positive steps to improve your overall wellbeing and quality of life, and potentially help improve seizure control.

Some methods of self-management include:

  • Keeping a seizure diary
  • Taking medication every day exactly as prescribed
  • Monitoring alcohol consumption and avoiding binge drinking
  • Avoiding recreational drugs
  • Monitoring caffeine intake – caffeine is a stimulant which can sometimes trigger seizures
  • Eating a healthy balanced diet
  • Regular exercise
  • Keeping a good sleep routine to ensure you get plenty of sleep
  • Addressing stress and anxiety
  • Taking precautions when feeling unwell as this is more likely to trigger a seizure
  • Monitoring hormonal changes – eg, in menstrual cycles or menopause
  • For some people, avoiding flashing/flickering lights

There is more information about Self management here.  We also have more specialised publications on seizure triggers which can help you understand more about seizure triggers and how to manage these.

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