Treatment

After Mayo Clinic's highly specialized epilepsy experts review your test results at a team conference, your neurologist will work with you to determine the best treatment options for you. At Mayo Clinic, treatment of epilepsy means finding the best method of seizure control, as well as addressing any related cognitive and psychosocial impairments — in other words, treating you as a whole person.

In most cases, epilepsy is first treated with medication. If medications don't treat the condition, your doctor may propose surgery or other therapies.

Medication

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking medications. Your doctor will advise you about the appropriate time to stop taking medications.

More than half the children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults also can discontinue medications after two or more years without seizures.

Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won't interact with them.

Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled.

Anti-seizure medications may have some side effects. Mild side effects include:

  • Fatigue
  • Dizziness
  • Weight gain
  • Loss of bone density
  • Skin rashes
  • Loss of coordination
  • Speech problems
  • Memory and thinking problems

More-severe but rare side effects include:

  • Depression
  • Suicidal thoughts and behaviors
  • Severe rash
  • Inflammation of certain organs, such as your liver

To achieve the best seizure control possible with medication:

  • Take medications exactly as prescribed.
  • Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
  • Never stop taking your medication without talking to your doctor.
  • Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors.
  • Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy.

At least half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your multi-disciplinary team of epilepsy experts to evaluate your condition and medications.

Surgery

Epilepsy surgery Epilepsy surgery

Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn't interfere with vital functions, such as speech, language, motor function, vision or hearing. At Mayo Clinic, experienced neurosurgeons perform more than 100 of these operations each year.

The procedures remove the area of your brain that's causing the seizures. Mayo Clinic neurosurgeons use intraoperative MRI to create accurate pictures of the brain that guide them in effectively removing the affected tissue, as the brain can shift during surgery. The goal is always to treat the epilepsy, but at Mayo Clinic, the neurosurgery team is very attentive to quality of life and will help you weigh the benefit of seizure reduction against potential side effects, including possible risk to other brain functions such as language or cognitive abilities.

If your seizures originate in an area of the brain that controls movement, speech and other functions, you may be awake during part of the surgery. Your subspecialized care team will monitor you and ask you questions during the procedure in order to pinpoint the precise area causing the seizures and lower the risk of damaging other functional areas of your brain.

If your seizures originate in a part of your brain that can't be removed, your doctor may recommend a different type of surgery in which neurosurgeons make several cuts in your brain (multiple subpial transection). These cuts are designed to prevent seizures from spreading to other parts of your brain.

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In a small number of cases, surgery for epilepsy can cause complications, such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering.

Therapies

  • Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.

    The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent.

    Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.

  • Ketogenic diet. A high-fat, low-carbohydrate diet that mimics the fasting state, called a ketogenic diet, was first used in the 1920s at Mayo Clinic. It has since been discovered to improve seizure control in children with epilepsy that cannot be controlled by medication. More than 100 Mayo Clinic pediatric epilepsy patients are currently on the diet.

    In the ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet and remain seizure-free.

    Mayo Clinic pediatric patients who are candidates for the diet begin it during a three- or four-day stay in the Mayo Eugenio Litta Children's Hospital so their parents can learn to manage the diet and the child's response can be monitored before the child is discharged. Mayo Clinic dietitians have designed more than 100 menus for families to download and are willing to create specific recipes on request.

    Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when taking the diet. Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies, and buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised.

Potential future treatments

Mayo Clinic researchers are constantly seeking new medical knowledge and have studied a type of stereotactic surgery called laser thermal ablation as a treatment for some types of epilepsy. Your neurosurgeon will discuss with you if you're a candidate for this procedure.

In this minimally invasive procedure, doctors make a small hole in the back of your skull and guide a laser-tipped thin tube (catheter) into your skull to the specific area of your brain that's causing your seizure. Light energy is then directed through the catheter to heat and destroy tissue in the specific area of your brain that's causing your seizure. This procedure is experimental and needs further research. Long-term results aren't yet known. However, the preliminary results of the research are promising.

Another potential treatment for epilepsy being studied at Mayo Clinic is the use of implantable brain stimulation devices. In these clinical trials, neurosurgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest or the skull that sends electrical pulses to your brain and may reduce your seizures.

Pacemaker for epilepsy

Mayo Clinic scientists are also studying stereotactic radiosurgery as a potential treatment for some types of epilepsy. In this procedure, doctors direct radiation at the specific area of your brain that's causing your seizure.

Your Mayo Clinic neurosurgeon will discuss with you if you're a candidate for any clinical trials on these promising new procedures.

Nov. 22, 2014
References
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