Treatments and drugs

By Mayo Clinic Staff

Medications

Numerous medications are available to treat temporal lobe seizures, including:

  • Carbamazepine (Carbatrol, Tegretol, others)
  • Phenytoin (Dilantin, Phenytek)
  • Valproic acid (Depakene, Stavzor)
  • Oxcarbazepine (Trileptal)
  • Lamotrigine (Lamictal)
  • Gabapentin (Gralise, Neurontin)
  • Topiramate (Topamax)
  • Phenobarbital
  • Zonisamide (Zonegran)
  • Levetiracetam (Keppra)
  • Tiagabine (Gabitril)
  • Pregabalin (Lyrica)
  • Felbamate (Felbatol)
  • Lacosamide (Vimpat)
  • Vigabatrin (Sabril)

However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common. In particular, the FDA has issued a warning that the drug Lamictal has been associated with a type of meningitis. Discuss possible side effects with your doctor when deciding about treatment options.

Surgery

Success rates for temporal lobe epilepsy surgery range from about 60 to 90 percent. Success, as defined in surgical outcome studies, means having no seizures or far fewer seizures. It doesn't mean discontinuing medication.

Surgery is generally not an option if:

  • Your seizures come from a region of the brain that performs vital brain functions
  • Your seizures come from more than one area
  • Where your seizures originate can't be identified

Preparing for surgery likely involves talking to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before having surgery.

Before surgery, you'll need:

  • A comprehensive evaluation
  • MRI scans of your brain
  • Observation of your seizures in a hospital-based monitoring unit using video recordings and EEG

In some cases, surgery to implant intracranial electrodes may be necessary before finally deciding about temporal lobe surgery.

After surgery, most people need to continue taking medication to help ensure that seizures don't recur. However, successful surgery often means being able to reduce the dose, and some people are able to stop taking medication. Infrequently, surgery can lead to neurological problems. Discuss the possible risks with your surgeon before making final decisions about surgery.

Radiosurgery

Researchers have been investigating the use of radiosurgery, which uses a Gamma Knife to deliver a precise dose of radiation to the damaged portion of the brain. This procedure is still considered experimental, and the anti-seizure effects as well as any side effects of the procedure may be delayed for one to two years.

Vagus nerve stimulation

A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck. The device turns on and off according to an adjustable program and can be activated with a magnet. The device doesn't detect seizures. It's usually well tolerated, but it's not a replacement for medication.

Pregnancy and seizures

The most important thing to remember is to plan pregnancy. Women who are on medications for seizures usually are able to have healthy pregnancies. However, the birth defect risk is about twice that of pregnant women who don't require seizure medications. Seizures pose a risk to a developing baby, so it is generally not recommended to stop medications during pregnancy. Discuss these risks with your doctor. Because pregnancy can alter medication levels, preconception planning is particularly important for women with seizures.

The risk of birth defects differs, depending on the seizure medication, and is considered to be higher in women taking more than one drug. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. If your seizures can't be well controlled with any other medication, discuss the potential risks with your doctor.

Contraception and anti-seizure medications

Some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.

Jun. 25, 2011