Epilepsy

Treatment

Test results required to diagnose epilepsy accurately are usually available within hours in Mayo Clinic's state-of-the-art electronic medical record. Once epilepsy is diagnosed, Mayo specialists work together to identify its cause and determine the most appropriate treatment for each patient.

Patients diagnosed with epilepsy may be treated with medications, surgery and vagus nerve stimulation. The ketogenic diet is also a treatment option for some children and adults. Treatments vary based on the type and severity of epilepsy.

Some patients can manage their epilepsy well with medication. Others may need surgery or vagus nerve stimulation. Some patients may also be eligible for clinical trials investigating new treatments such as deep brain stimulation.

Medications

More than a dozen medications are currently approved by the U.S. Food and Drug Administration (FDA) to treat epilepsy. Each has benefits and side effects.

Different medications are appropriate for different types of epilepsy. No single medication has proven to be effective for all types of epilepsy. Only a complete evaluation can determine which medication will work best for each patient.

Long-term use of some anti-epileptic medications may adversely affect bone health. Osteoporosis is known to be associated with some anti-epileptic medications. At Mayo Clinic, patients taking anti-epileptic medications receive periodic bone density studies to monitor bone weakening.

A Mayo Clinic study found that young male epilepsy patients with normal bone density experienced seizure-related vertebral compression fractures, which appeared to result from bone demineralization caused by anticonvulsants prescribed to control seizures.

Women and Medication

Careful medication selection 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, although most women with epilepsy deliver healthy babies.

Read more about treatment considerations for women.

Mayo Clinic epilepsy patients nearly or completely seizure-free after surgery

Mayo Clinic epilepsy surgery volumes

Surgery

Patients with epilepsy 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 specialists determine if surgery is the most appropriate option for patients with epilepsy.

Surgery for Partial Seizures

Patients who have partial (originating in one part of the brain) seizures may be candidates for surgery to remove that part of the brain. This surgery is recommended only if the seizure origination point can be pinpointed and the surgery will not jeopardize normal function. SISCOM, an imaging technique developed at Mayo Clinic, accurately locates seizure hot spots, allowing the neurosurgeon to remove them safely.

Mayo neurosurgeons may remove seizure hot spots with awake brain surgery. Brain mapping, which identifies the areas of the brain controlling different functions, is performed while the patient is alert. The patient is asked to respond to questions to ensure that surgery doesn't adversely affect functions such as speech and movement.

Mayo Clinic research has found that surgery to treat partial seizures that did not respond to other medical treatment to be successful during the longer periods. In 2006, a Mayo Clinic study indicated that 81 percent of patients with intractable (treatment-resistant) epilepsy became totally or nearly seizure-free six months following epilepsy surgery. Ten years later, 72 percent remained totally or nearly seizure-free.

Surgery for Generalized Seizures

Patients who have generalized (affecting both sides of the brain) seizures usually are not candidates for surgery. If seizures result in falls and injuries, however, corpus callosotomy (a procedure that separates the nerve fibers that connect the two halves of the brain) may be considered. This surgery does not cure epilepsy or completely stop seizures, but it may reduce the number and severity of seizures and related falls and injuries.

Vagus nerve stimulation

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Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) is approved to treat partial seizures in patients age 12 and older. VNS can reduce seizure frequency and intensity in some patients. Up to 50 percent of patients can expect reduced seizure activity with VNS.

The stimulator is surgically implanted under the skin in the chest. 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. The stimulator is adjusted to automatically deliver mild electrical signals to the vagus nerve in intervals ranging from every few seconds to every few minutes.

The patient or caretaker may also turn the stimulator on with a magnet. A physician can easily adjust the stimulator to increase or decrease the signal frequency. The stimulator does not detect seizure activity.

VNS requires a one-night stay for most patients.

Ketogenic Diet

The ketogenic diet has been used primarily in the treatment of childhood epilepsy. Less-strict versions of the ketogenic diet, such as a modified Atkins™ or low glycemic diet, are now also used to treat some adults with epilepsy.

Learn more about the kenogetic diet.

Investigational Medications and Treatments

Despite available medical and surgical treatments, more than 600,000 Americans have epilepsy that is not well controlled by the treatments currently available.

Mayo Clinic is committed to developing new medications and treatments for patients with epilepsy. New medications not yet approved by the FDA may be an option for patients whose seizures are not controlled by current FDA-approved medications.

Mayo researchers conduct clinical trials to test new medications and devices to treat medically resistant epilepsy. To ensure their safety, patients are carefully evaluated before they are chosen and closely observed as they participate in clinical trials.

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.

Learn more about epilepsy clinical trials at Mayo Clinic.