Treatment Goals
The goal of epilepsy treatment is to help you become as close to seizure-free as possible. Medicine can help prevent seizures, and today, many different antiseizure medicines are available.
Epilepsy is commonly a long-term illness, so you should talk to your doctor about your immediate needs and long-term goals. The treatment of epilepsy focuses on these main goals:- Good control of seizures
- As few side effects as possible
- As few interactions with medicines as possible
- Improved quality of life
- Resuming normal growth and development in children
Sometimes, epilepsy can be controlled by one medicine (monotherapy); at other times, two or more medicines (add-on therapy) are needed to better control seizures. You may find that by taking medicine, you have fewer or milder seizures—or that your seizures are prevented altogether.
It may take some time working together with your doctor to find the right antiseizure medicine(s). Not only do you want to find the medicine(s) that best control(s) seizures, you want to find medicines that you can comfortably take with minimal side effects.
You can help by:- Discussing your individual treatment goals with your doctor.
- Taking the Treatment Satisfaction Questionnaire and discussing your answers with your doctor.
- Keeping track of your seizures and how you feel on a daily basis using the Events Calendar to share with your doctor at each visit.
The importance of continuing your antiseizure medicine(s)
It's natural to want to stop taking medicine once you feel better. After all, you stop taking cold medicine once the cold is gone, and you don't take aspirin after your headache is gone. But that's not the case with epilepsy.
It is very important to keep taking antiseizure medicine for as long as your doctor prescribes it—and never stop taking antiseizure medicine without specific instructions. That means taking your antiseizure medicine even after the seizures are under control and you are feeling better.
If you experience problems with your antiseizure medicine, call your doctor.
Stopping the antiseizure medicine without a doctor's advice is one of the major reasons people who have been seizure-free may start having break-through seizures. Seizures that result from stopping medicine can be very serious.
Will you ever be able to stop taking antiseizure medicine?
Some doctors will advise people to stop their antiseizure medicine after 2 years have passed without a seizure, and some will want to wait 4 or 5 years. Whether you or your loved one will be able to stop taking antiseizure medicine depends upon many factors, including age and type of epilepsy.
People who are less likely to be able to discontinue treatment are those who:- have a family history of epilepsy
- take more than one medicine for epilepsy
- experience partial seizures
- continue to have abnormal electroencephalography (EEG) results while on medicine
If you are pregnant or thinking about becoming pregnant, don't stop taking your antiseizure medicine, but inform your doctor immediately. You may need to make changes in your antiseizure medicine before or during your pregnancy.
Other treatment options
In addition to medication, other types of treatment for seizure disorders include:- Surgery - When seizures cannot be adequately controlled with medication, doctors may recommend that a person be evaluated for surgery. Surgery can involve removing damaged sections of brain tissue, or it can involve making a series of small cuts to prevent seizures from spreading to other parts of the brain. However, surgery for epilepsy does not always successfully reduce seizures, and surgery can cause changes in personality or brain function.
- Vagal nerve stimulation - The vagus nerve stimulator was approved by the FDA in 1997 for use in people with seizures that are not well-controlled by medication. The stimulator is a battery-powered device that is surgically implanted under the skin of the chest, much like a pacemaker, and is attached to the vagus nerve in the lower neck. The device delivers short burses of electrical energy to the brain that can reduce seizures.
- Ketogenic diet - Studies have shown that, in some cases, children may experience fewer seizures if they maintain a strict diet rich in fats and low in carbohydrates. This unusual diet, called the ketogenic diet, causes the body to break down fats instead of carbohydrates to create a condition called ketosis. Researchers are not sure how ketosis inhibits seizures. People who try this diet should seek the guidance of a dietician to ensure that it does not lead to serious nutritional deficiencies and other problems such as kidney stones.