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 and, increasingly, for some adults. The same treatment does not work for every patient because the type and severity of epilepsy varies. Some patients can manage their epilepsy well with medication. Others may need surgery or vagus nerve stimulation. Some patients may be eligible for clinical trials investigating new treatments such as deep brain stimulation and new medications.

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 single medication has proven to be the best treatment for epilepsy. Only a complete evaluation can determine which medication will work best for each patient.

Choosing the most appropriate medication is especially important for women. Medication can both affect and be affected by hormones, whether natural or prescribed for contraception. Anti-epileptic medication also raises the risk of birth defects (though most women with epilepsy deliver healthy babies). Read more about treatment considerations particular to women.

Long-term use of some anti-epileptic medications can also adversely affect bone health in women and men. Osteoporosis is known to be associated with some anti-epileptic medications. Patients taking them have periodic bone density studies to monitor bone weakening. A recent Mayo Clinic study found that even young male epilepsy patients with normal bone density scores were experiencing seizure-related vertebral compression fractures. The study pointed out the need to find ways to accurately predict this risk and to prevent fractures.

Surgery

Patients who do not respond well to medication may be candidates for surgery. Mayo Clinic offers different surgical procedures for different types of epilepsy. Sophisticated diagnostic tests help determine if surgery is the best option.

Surgery for Partial Seizures

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

With another type of surgery, awake brain surgery, neurosurgeons can remove seizure hot spots. During part of the surgery, the patient is awake and asked to respond to questions to ensure that surgery doesn't adversely affect functions such as speech and movement.

Surgery to treat partial seizures that have not responded to other medical treatment is highly successful over the long term. In 2006, Mayo Clinic researchers published a study of 399 Mayo Clinic patients who had epilepsy surgery. The researchers found that 81 percent of patients with intractable epilepsy (treatment resistant) become totally or nearly seizure-free six months following epilepsy surgery. Ten years later, 72 percent remained totally or nearly seizure-free. See epilepsy study news release.

Surgery for Generalized Seizures

Patients who have generalized seizures (affect both sides of the brain) usually are not candidates for surgery. However, if the seizures result 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 related falls and injuries.

Vagus Nerve Stimulation (VNS)

Vagus nerve stimulation (VNS) is approved to treat partial seizures in patients 12 and older. VNS can reduce 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 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 with 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 has traditionally been used primarily in treating childhood epilepsy. The diet, especially less strict versions (a modified Atkins diet or a low glycemic diet), is now also being used in treating adults and may be an option for some patients. It is offered only at Mayo Clinic's Rochester, Minn., campus. See Treatment of Children with Epilepsy for more information.

Investigational Treatments

Despite available medical and surgical treatments, more than 600,000 Americans have epilepsy that is not well controlled by medical treatments. Mayo Clinic physicians are pursuing research to develop and test new treatments. They are involved in research studies (clinical trials) to test new medications and devices to treat medically resistant epilepsy. To ensure safety, patients are carefully evaluated and closely observed while participating in clinical trials. See epilepsy clinical trials at Mayo.

Investigational Medications

New medications not yet approved by the Food and Drug Administration (FDA) are an option for patients whose seizures are not controlled by the common, FDA-approved medications.

Investigational Brain Stimulation Device

Mayo Clinic investigators are enrolling patients in a national multicenter clinical trial to test the effectiveness of brain stimulation in treating epilepsy. Carefully selected patients with medically resistant partial epilepsy are candidates for this clinical trial.