Treatments to help reduce seizure frequency have come a long way in the past few decades. Today, you and your care team can choose from medications, dietary approaches, devices, surgeries, or a combination of those to help bring your seizures under better control.
The right plan depends on your seizure type, overall health, and how your epilepsy responds to treatment. Here’s what to know about your options and how to think through them.
Anti-Seizure Medications
Seizures happen because of sudden, abnormal bursts of electrical activity in your brain. These bursts keep your nerve cells from communicating normally. This causes symptoms such as loss of consciousness, convulsions (rapid, involuntary, and violent muscle contractions), or vacant staring, chewing, clicking, or other repetitive movements.
In most cases, treatment starts with anti-seizure drugs, or ASDs.
“Medications are the mainstay of treatment for people that have epilepsy,” says Robert McInnis, MD, assistant professor of clinical neurology at Weill Cornell Medical College.
These medications work by stabilizing electrical activity in your brain to reduce the chance of the abnormal firing that leads to seizures. They address seizures, but they don’t have an effect on the underlying trait that causes epilepsy.
There are more than 30 approved anti-seizure medications. Your doctor will match one to your seizure type. Some common options include drugs like lamotrigine, levetiracetam, and valproate. About two-thirds of people with epilepsy can control their seizures with medication alone.
If your seizures continue even after you’ve tried two medications, doctors classify this as drug-resistant or refractory epilepsy. This is when your doctor may start to explore other treatment options beyond medication.
Surgery
Once you’ve tried two medications and haven’t seen a change in your seizures, your doctor may discuss surgery options. Sometimes, surgery can drastically reduce seizure frequency or even stop them entirely.
“In people with focal epilepsy, seizures start from a specific part of the brain,” says McInnis. "We may be able to remove or disconnect that part of the brain, as long as it isn’t involved in important functions like speech.”
If you have drug-resistant epilepsy, surgery may be life changing. But brain surgery is a major decision. You’ll have many tests beforehand, including brain imaging and sometimes inpatient monitoring to map where your seizures are starting in your brain. Risks include memory changes, vision problems, or other neurologic effects, depending on the surgery.
Implantable Devices
If surgery isn’t an option, or it doesn’t fully control your seizures, implantable devices may help reduce how often seizures happen.
One of the most common such implants is vagus nerve stimulation (VNS). A doctor places a device under your skin in your chest, and it sends regular electrical signals through your vagus nerve to your brain. Over time, it can reduce your seizure frequency and severity.
Another option is responsive neurostimulation (RNS). This involves implanting a device in your skull to monitor brain activity in real time. When it detects patterns that may lead to a seizure, it delivers a small electrical pulse to interrupt it.
Deep brain stimulation (DBS) is also used in some cases. It targets specific brain regions involved in seizure activity.
These devices don’t usually stop seizures completely, but they may reduce how often they happen and make them less severe. Side effects are generally mild. They may include hoarseness with VNS or surgical risks related to implantation.
Dietary Therapy
Diet may also play a role in seizure control, particularly if your seizures don’t respond well to medication.
Specifically, doctors have studied the ketogenic diet as an aid for people with treatment-resistant epilepsy. When you follow the ketogenic diet, you restrict your carbohydrates and focus instead on getting fuel from fats and some protein. That makes your body use ketones for energy instead of glucose, which may help stabilize brain activity and reduce seizures.
“We find that in people who are able to sustain the ketogenic diet, it can in some circumstances reduce seizures by up to 50%,” says McInnis. “If you’re having frequent seizures, that can make a meaningful difference.”
Dietary therapy isn’t something to try on your own. You need medical supervision and guidance from a dietitian to ensure you’re getting enough nutrients. Side effects can include bad breath, constipation, kidney stones, and high cholesterol.
McInnis says it can be hard to stick with the ketogenic diet for a long period of time. A modified Atkins diet (which is similar to the ketogenic diet but less strict) may be easier to follow while also helping to reduce your seizures.
Supportive Habits
In addition to medical treatments, your doctor can suggest lifestyle changes that support your overall health and epilepsy management. Getting enough sleep, managing stress, avoiding known seizure triggers, and limiting alcohol help reduce your risk of seizures.
Show Sources
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SOURCES:
Robert McInnis, MD, assistant professor of clinical neurology, Weill Cornell Medical College, Cornell University.
CDC: “Types of Seizures,” “Epilepsy: Health and Safety Concerns.”
Cleveland Clinic: “Antiseizure Medications (Formerly Known as Anticonvulsants),” “Ketosis.”
Epilepsy Foundation: “How Seizure Medicines Work,” “Vagus Nerve Stimulation,” “Responsive Neurostimulation.”
American Epilepsy Society: “A Summary of Antiseizure Medications Available in the United States: 4th Edition.”
Neuropsychiatric Disease and Treatment: “Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies.”
World Neurosurgery: “Drug resistant epilepsy and ketogenic diet: A narrative review of mechanisms of action.”
Johns Hopkins Medicine: “Ketogenic Diet Therapy for Epilepsy.”
