Epilepsy Treatments and Medications

Living with recurring seizures and moments of unconsciousness can be frustrating and scary. These symptoms typically indicate a case of epilepsy, which can be confirmed through lab tests after speaking with your doctor.

Understanding what epilepsy is and the at-home and prescription medication treatment options available are the first steps in managing your condition.

What is epilepsy?

Epilepsy is a neurological condition in which abnormal electrical activity in the brain causes seizures, loss of consciousness, and other atypical sensations and behaviors. Epilepsy can be the result of a genetic disorder, medical condition, or a brain injury caused by abnormal development, trauma, cancer, surgery, or stroke.

There are various types of epilepsy or types of seizures one can experience. Focal or partial seizures occur when the electrical activity prompting the seizures is localized to a particular part of the brain. Generalized seizures are the opposite, where there is widespread activity across multiple areas of the brain. Types of generalized seizures include absence seizures (or petit mal seizures), tonic-clonic seizures (or grand mal seizures), atonic seizures, clonic seizures, tonic seizures, and myoclonic seizures.

In 2015, there were 3.4 million adults and 470,000 children with active epilepsy in the United States, according to the CDC. Epilepsy used to be a mysterious condition that was difficult to diagnose and treat, especially because approximately one-third of patients develop drug-resistant seizures. But with medical advancements in the past decade, new technologies are helping to make treatment more effective.

New research and development for epilepsy is focusing on pinpointing the source of epileptic seizures, particularly for those who have drug-resistant epilepsy and offering less-invasive options than surgical treatment. Technologies like stereo-electroencephalography (SEEG), laser ablation, and responsive neurostimulation are all being developed to tackle different facets of the condition.

SEEG is a diagnostic tool that uses thin electrodes in the head to monitor brain activity and find the causes for one’s seizures. Laser ablation is a treatment method that is then used to target the brain tissues where the seizures originate with thin lasers. Neurostimulation is an option for controlling seizures by implanting a device in the brain that delivers electrical impulses to reduce seizures. Clinical trials have shown these devices can reduce seizures by up to 80 percent.

How is epilepsy diagnosed?

Someone who experiences a seizure should speak with a healthcare provider immediately, especially for those who exhibit key risk factors such as recurrent seizures, severe head trauma, family history of epilepsy, stroke, brain infections, or dementia.

When you speak with your primary care provider about your seizures, the provider will ask you questions about what happened leading up to, during, and after the seizures to try to understand the cause. Your provider will likely refer you to a specialist such as a neurologist or an epileptologist who focuses on treating nervous system disorders like epilepsy.

Lab tests or imaging are often required to diagnose epilepsy. One of the most common tools used to diagnose epilepsy is an electroencephalogram (EEG) test. During an EEG, electrodes are attached to the scalp to record your brain’s electrical activity and monitor for irregularities. Other tests for diagnosing epilepsy may include blood tests, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.

Blood tests may be used to detect levels of the hormone prolactin in the blood. CT and MRI scans are used to reveal any abnormalities or lesions in a particular area of the brain that could cause seizures such as cysts, tumors, and bleeding.

Epilepsy treatment options

After receiving a diagnosis for epilepsy, your health care provider should go over all of your treatment options with you. Treatment plans will vary by case, and be determined based on the types of seizures you have, how they affect you, your age, and your lifestyle.

The most common treatment methods for epilepsy include anti-epileptic drugs (AEDs), epilepsy surgery, and device therapies such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS), and dietary changes like the ketogenic diet.

There is no current cure for epilepsy, but treatment can help control your seizures. Preventative methods may also help to reduce the frequency of epileptic episodes. These methods include sleeping regularly, managing stress, eating healthy, avoiding illicit drugs and alcohol, and avoiding bright, flashing lights.

Epilepsy medications

There are a wide range of medications available for epilepsy treatment, including anticonvulsants, benzodiazepines, and barbiturates. Some people may need more than one drug to control their seizures. Combination therapy is usually more effective than single medication. To achieve the best results through your treatment of epilepsy, take medications exactly as prescribed and consult with your doctor before stopping a medication or adding other treatments. Abruptly stopping a medication can lead to severe exacerbation of epilepsy.

Anticonvulsants

Anticonvulsants, also known as anti-epileptic drugs (AEDs) or anti-seizure drugs, are commonly prescribed to treat epilepsy. Seizures are triggered by abnormal activity in excitatory and inhibitory neuronal circuits of the brain. Anticonvulsant drugs work by decreasing excitation or enhancing inhibition. The mode of this action includes interacting with neurotransmitters (GABA and glutamate) in the synapses or ion channels in the cell membrane.

Seizures can occur either in a localized section of the brain (focal epilepsy) or throughout the brain (generalized epilepsy). People who typically experience focal epilepsy may be prescribed a narrow-spectrum AED like Neurontin (gabapentin) or Lyrica (pregabalin). Those who experience generalized epilepsy may be prescribed broad-spectrum AEDs like Felbatol (felbamate), Keppra (levetiracetam), Topamax (topiramate) or Depakene (valproic acid).

The common mild side effects of anticonvulsant drugs include nausea, abdominal pain, dizziness, mood changes, sleepiness, and trouble concentrating. Some may experience more severe side effects, such as blood problems, liver problems, or more seizures. Your doctor can help explain the potential risks and benefits of any prescribed medications. Be sure to contact your primary care provider if you experience any unusual side effects after starting medication.

Benzodiazepines

Benzodiazepines work as a sedative and anticonvulsant by acting on the GABA receptors in the brain. They can be very effective for short-term use but may lose their effect over time as your brain adjusts to the medication. Common benzodiazepines used for epilepsy treatment include diazepam, lorazepam, and clobazam.

Barbiturates

Barbiturates such as phenobarbital interact with the GABA neurotransmitter to suppress the activity of the central nervous system and inhibit seizures. Common side effects of barbiturates like phenobarbital are nausea, vomiting, dizziness, rash, and drowsiness.

Phenobarbital has a long history of effective use for epilepsy treatment and is low-cost, but it is also a habit-forming drug that can cause withdrawal seizures. Your doctor may recommend a slow reduction in dosage to avoid withdrawal symptoms.

What is the best medication for epilepsy?

“Many medications are available to treat epilepsy with newer ones being developed and made available, but there is no one best medication,” says Dr. Uma Menon, neurologist and epilepsy/seizure disorders specialist of Ochsner Medical Center in New Orleans.

“Medications prescribed for epilepsy depends on many factors. The type of seizure/epilepsy, the severity, and the frequency of seizures, other illnesses the patient might have, how the patient responds to certain medications, side effect tolerance and so on,” says Dr. Menon.

Some patients require multiple medications to control seizures. Consult with your doctor to determine the best epilepsy medication for you.

See common epilepsy medications in the comparison chart below.

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Best medications for epilepsy