Epilepsy Treatments and Medications

Epilepsy is a condition that causes repeated bouts of abnormal electrical activity in the brain called seizures. A seizure can cause someone to lose consciousness and have uncontrolled movements (convulsions), among other symptoms. The exact causes of epilepsy can vary, although factors like genetics, brain injuries, strokes, and infections can play a part. Different types of seizures can affect multiple parts of the brain, and while it can’t be cured completely, epilepsy can usually be managed with prescription medicine.

How is epilepsy diagnosed? 

Epilepsy can be a complex condition, which means it often needs to be diagnosed by a healthcare provider who specializes in brain disorders, such as a neurologist. A diagnosis generally involves looking at a person’s medical history and conducting brain imaging tests.

• Medical history: A healthcare provider will ask about potential causes of the seizures and whether there’s a family history of epilepsy or other risk factors.

• An electroencephalogram (EEG): This test uses electrodes to assess brain electrical activity and check for patterns associated with epilepsy. 

• Brain imaging: A healthcare provider may recommend an MRI or CT scan to see if a tumor, scar, or other brain trauma is causing seizures. 

• Blood tests: A complete blood count and other tests can check for infection, electrolyte imbalances, or other issues that could trigger seizures. 

These tests can help rule out different causes of seizures. If epilepsy is causing the seizures, a healthcare provider can recommend a plan to control seizures and improve overall quality of life. 

Epilepsy treatment options

While no treatment will cure epilepsy, different options can help reduce seizures. An anticonvulsant or antiseizure medication is usually the first-line treatment, with several different types available. The right drug will depend on the type of seizures occurring and a person’s overall health condition. In cases where epilepsy doesn’t improve with medication, a healthcare provider may recommend surgery or a procedure like vagus nerve stimulation. It’s always important to follow a healthcare provider’s instructions when starting a new treatment, since making any changes could increase the risk of seizures.

Types of epilepsy medication

Antiseizure medications, also known as anti-epileptic drugs or anticonvulsants, are the main treatment for epilepsy. They can help reduce excessive electrical activity in the brain, which may help control how often seizures occur. 

Broad-spectrum antiseizure medications

Broad-spectrum antiseizure drugs are often used as a first-line option, especially if the exact type of seizure is still unknown. Common options include Keppra (levetiracetam), Lamictal (lamotrigine), Depakote (divalproex sodium), and Topamax (topiramate). Levetiracetam and lamotrigine are usually used first for generalized seizures, while ethosuximide is first-line for people with absence seizures. While valproate medications are effective, they shouldn’t be used in women who are pregnant or want to become pregnant due to the risk of birth defects.

Narrow-spectrum antiseizure medications

Narrow-spectrum antiseizure medications are typically used for focal seizures. Examples include Tegretol (carbamazepine), Trileptal (oxcarbazepine), Vimpat (lacosamide), and Dilantin (phenytoin). Neurontin (gabapentin) and Lyrica (pregabalin) are sometimes used in addition to other antiseizure medications for focal seizures. Newer options like Xcopri (cenobamate) are used for focal seizures that are hard to control. 

Benzodiazepines 

Benzodiazepines can help quickly alleviate a seizure by acting on the GABA receptors in the brain. They can be effective for short-term use, but may lose their effectiveness over time with daily use. Examples include diazepam, midazolam, and lorazepam, which may be used as rescue treatments for different seizures. 

Barbiturates

Barbiturates work on GABA receptors to help prevent or stop seizures. Phenobarbital is a commonly used barbiturate for managing seizures. However, using it long-term can lead to dependence and withdrawal seizures if it’s stopped abruptly.

Over-the-counter epilepsy medicine

There are no over-the-counter medicines that can treat epilepsy. In fact, some products could actually trigger or worsen seizures, including decongestants like pseudoephedrine and certain antihistamines like diphenhydramine in large amounts. Supplements like St. John’s wort and ginkgo could also trigger seizures. Always check with a healthcare provider or pharmacist before taking an over-the-counter product if you have seizures.

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