Epilepsy

Treatment

The main treatment options for people with epilepsy are medications, surgery and vagus nerve stimulation. The ketogenic diet is a treatment option for some children. It is important to know that the same treatment does not work for every patient because the type and severity of epilepsy varies from patient to patient. Some patients will manage their epilepsy very well with medication while others will be better served by having surgery or using vagus nerve stimulation.

Medications

More than a dozen medications are currently approved to treat epilepsy. Each medication has benefits and side effects, and different medications are appropriate for different types of epilepsy. No one medication is proven to be the best treatment for epilepsy. Only a complete evaluation can determine which medication will work best for each patient.

Investigational Medications

New medications that are being studied but are not yet approved by the Food and Drug Administration (FDA) are another option for patients whose seizures are not controlled by the common, FDA-approved medications. Mayo Clinic physicians are involved in many research studies, called clinical trials. Patients receive research medications as volunteers in research studies. To ensure safety, patients are carefully evaluated and closely observed while participating in clinical trials.

Surgery

Patients who do not respond well to medication may be candidates for surgery. Mayo Clinic offers different types of surgery for different types of epilepsy. A variety of sophisticated diagnostic tests will be used to determine if surgery is the best option.

Patients who have partial seizures that originate in one part of the brain may be candidates for surgery to remove that part of the brain. This surgery is done only if it does not jeopardize normal function, and the part of the brain from which the seizure originates can be precisely pinpointed. A technique developed at Mayo Clinic called SISCOM accurately locates seizure "hotspots," allowing the neurosurgeon to remove them safely.

Awake Brain Surgery

Another type of surgery, awake brain surgery, allows neurosurgeons to remove seizure hotspots while keeping the patients awake to test functions such as speech and movement. Read more about awake brain surgery.

Corpus Callosotomy

Patients who have generalized seizures are not usually candidates for surgery. However, if the seizures are resulting in falls and injuries, a procedure called "corpus callosotomy" may be considered. This procedure involves separating the nerve fibers that connect the two halves of the brain. While this surgery does not cure epilepsy or completely stop seizures, it can reduce the number and severity of seizures and the related falls and injuries.

Vagus Nerve Stimulation (VNS)

Vagus nerve stimulation (VNS) is approved to treat partial seizures in patients 12 years of age or older. VNS can lead to a reduction in seizure frequency and intensity in some patients. Approximately 30 to 50 percent of patients can be expected to have less seizure activity with VNS.

The vagus nerve stimulator is surgically implanted under the skin in the chest. The surgery requires a one-night stay only for most patients. The device is attached to a wire that is tunneled under the skin and attached to the vagus nerve, which is located in the left side of the neck (see picture).

The vagus nerve stimulator is adjusted to automatically stimulate the vagus nerve from every few seconds to every few minutes. The patient or caretaker can also turn the stimulator on by using a magnet. The device does not detect seizure activity. It can be adjusted easily in a physician's office using a laptop computer.

Ketogenic Diet

The ketogenic diet is primarily used in childhood epilepsy. It is offered only at Mayo Clinic in Minnesota. See Treatment of Children with Epilepsy.