Treatment Options for Epilepsy
“No seizures, no side effects” is the goal of epilepsy treatment. Not every person will reach that goal right now, but research and specialty care help more people achieve it each year. While seizure medications are the mainstay of epilepsy treatment, there are other approaches to consider as well.
Click below to learn more about epilepsy treatment options.
Anti-epileptic drugs (AEDs) are the main form of treatment for people with epilepsy. In fact, seven in 10 people with epilepsy could have their seizures completely controlled with AEDs. There are approximately 26 different medications used to treat seizures, and different drugs work for different seizure types. It is not a one-size-fits-all approach, and the majority of people may require two or more AEDs to achieve seizure control. Getting the same version of AEDs with each prescription may contribute to how well the drug works for that person. Switching to a different version of a drug could cause confusion, anxiety, side effects, or a breakthrough seizure in some people. Medication compliance is critical!
A prescription medication containing cannabidiol (CBD) was approved in June 2018 by the FDA for controlling seizures in people with difficult-to-treat childhood-onset epilepsy. This new CBD medication, Epidiolex, is used to treat seizures associated with Dravet Syndrome, Lennox-Gastaut Syndrome, and Tuberous Sclerosis Complex. It is only available from a specialty pharmacy.
In September 2018, the FDA transferred Epidiolex to Schedule V of the Controlled Substance Act, making it the lowest category of schedule substances. While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a “high.”
If someone has tried at least three medications and none of them are working, brain surgery may be the answer. It involves testing to determine which area of the brain needs to be operated on. While brain surgery used to involve going through the cranium to remove part of the brain, surgeons can now point a laser at the part of the brain to be removed. The laser disintegrates that part like a tumor, so recovery is much quicker and the process is much less invasive.
A medically prescribed ketogenic diet can be an effective treatment for some people with epilepsy. The ketogenic diet is used primarily to treat severe childhood epilepsy that has not responded to standard AEDs. It is important to note that it is a medical treatment–not a fad diet. It is based on a finding that burning fat for energy has an anti-seizure effect. This strict diet includes high fat content and low sugar, carbohydrate, and protein intake. It requires strong family, school, and caregiver commitment–no cheating is allowed for the diet to be effective.
When initiating the ketogenic diet, children are usually hospitalized for seven days to go into a state of ketosis (under the supervision of doctors and nutritionists) before they are released to do the diet at home under the supervision of their caregivers. Some individuals will still require AEDs while on the diet. The child usually remains on the diet for two years, and then is gradually weaned back to a regular, healthy diet.
Neurostimulation devices include a vagus nerve stimulator (VNS) and a responsive neurostimulation system (RNS).
VNS is a device implanted just under the skin in the chest with wires that attach to the vagus nerve in the neck. It is sometimes referred to as a “pacemaker for the brain.” It delivers intermittent electrical stimulation to the vagus nerve that relays impulses to widespread areas of the brain. If a person is aware of when a seizure happens, they can swipe a special magnet across the chest to send an extra burst of stimulation to the brain, which can prevent or reduce the severity of an oncoming seizure. VNS is used primarily to treat focal (partial) seizures when medication is not effective. The most common side effect is a change in vocal quality (hoarseness) when the VNS pulse goes off. VNS has been approved by the FDA for use in people 4 years of age and older.
RNS is a device implanted on the cranium during surgery and is also similar to a heart pacemaker. It is designed to work in three key ways:
- Monitor brain waves all the time--even during sleep
- Detect unusual electrical activity that can lead to a seizure
- Respond quickly (within milliseconds) to seizure activity by giving small bursts or pulses of stimulation to help brainwaves return to normal, even before a seizure could occur
The FDA has approved RNS to treat focal (partial) seizures in people 18 years of age and older.