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Accurate diagnosis of the type of epilepsy a person has is critical to determining the right treatment. It's also important to begin treatment as quickly as possible to avoid any harm that can be caused from ongoing seizures. The standard treatment for epilepsy is medication, called antiepileptic or antiseizure medication. Although antiepileptic medications don't cure epilepsy, they help prevent seizures in about 70 percent of people who take them. Other treatment approaches include the ketogenic diet, vagus nerve stimulation and surgery.

More than 20 medicines are available to treat epilepsy. You and your health care professional will decide which one is right for you based on the type of seizures you have, your lifestyle and age and, for women, how likely you are to become pregnant. Some of the more common drugs used to prevent seizures include:

• Acetazolamide (Diamox)
• Adrenocorticotropic hormone (ACTH)
• Carbamazepine (Tegretol, Tegretol XR, Carbatrol)
• Clonazepam (Klonopin)
• Clorazepate (Tranxene)
• Diazepam (Diastat, Valium)
• Divalproex sodium (Depakote)
• Ethosuximide (Zarontin)
• Felbamate (Felbatol)
• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Oxcarbazepine (Trileptal)
• Phenobarbital (Luminal Sodium)
• Phenytoin (Dilantin)
• Primidone (Mysoline)
• Tiagabine (Gabitril)
• Topiramate (Topamax)
• Valproic acid (Depakote, Depakote ER)
• Zonisamide (Zonegran)

You and your health care professional most likely will need to work through a trial-and-error period to determine the drug and dosage that works best for you. While the goal usually is to treat with just one type of drug, some individuals with epilepsy will need to use more than one medication to reduce their seizures. When more than one drug is necessary, usually no more than one new medication is added at a time so that interactions or side effects can be monitored. Some drugs will need to be taken once a day while others must be taken several times. It's extremely important to take the drugs as directed.

Medication Side Effects

Side effects from antiepileptic drugs vary from person to person. The goal of medication therapy is to find the right drug (or combination) at the right dosage so you don't experience side effects. Some common side effects include memory and thinking impairment, fatigue, dizziness or weight gain. Severe side effects range from allergic reaction (including rash or difficulty breathing) to slurred speech and bone loss, which can lead to osteoporosis over the long term. Certain seizure medications may also increase the risks for birth defects. Other possible medication side effects may include excessive hair growth, mood changes, depression and irritability. It's important to report all side effects to your health care professional so he or she can tailor the dosage to suit you. If you experience severe side effects, don't wait; call for help immediately.

Antiepileptic Medication and Hormonal Contraceptives

Certain antiepileptic drugs can make contraceptives containing hormones ineffective and increase your risk for an unplanned pregnancy. Hormonal birth control includes oral contraceptives (birth control pills), long-acting progestin shots, implants and skin patches that release hormones. Antiepileptic drugs that may reduce hormonal contraceptive effectiveness include:

• Carbamazepine (Tegretol, Tegretol XR, Carbatrol)
• Oxcarbazepine (Trileptal)
• Phenobarbital (Bellatal, Luminal, Solfoton)
• Phenytoin (Dilantin, Phenytek)
• Felbamate (Felbatol)
• Topiramate (Topamax)

Antiepileptic medications that do not interfere with hormonal birth control are:

• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Pregabalin (Lyrica)

Women who take antiepileptic medications can use all other types of birth control methods, including barrier methods (diaphragms, spermicidal vaginal creams and gels, the contraceptive sponge, intrauterine devices, cervical caps and condoms). Discuss your options, preferences and lifestyle considerations with your health care professional to help you choose a method that works best for you.

Pregnancy and Epilepsy

With proper care, women with epilepsy have more than a 90 percent chance of having a normal pregnancy and a healthy baby. But as with other chronic conditions (such as diabetes or high blood pressure), women with epilepsy should be closely monitored, ideally before conception, during pregnancy and after delivery. Because pregnancy affects your weight and body metabolism, it can affect blood levels of antiepileptic medications. One of the most important considerations for a woman with epilepsy who is pregnant or considering pregnancy is to work with a health care professional who is knowledgeable about seizure disorders.

About two-thirds of women with epilepsy experience no change in their condition during pregnancy. Twenty-five to 40 percent experience more seizures and a minority see some improvement. Following birth, seizures usually revert to what they were like prior to pregnancy.

When giving birth, women with epilepsy are slightly more likely to experience hemorrhage, eclampsia, premature labor and cesarean sections, but epilepsy alone is not an indication for these procedures.

There is some increased risk (four to six percent for women with epilepsy compared to two to three percent for the general female population) that your child may have a birth defect such as cleft lip or palate, heart abnormalities or neurological problems. The risk is higher if you are on more than one antiepileptic medication during pregnancy. Experts recommend that you work closely with your health care professional to ensure that you're taking the appropriate antiepileptic medication and dose to minimize the risk of seizures during pregnancy and to minimize the risk of birth defects.

Your health care professional may adjust your medications if you are pregnant or plan to become pregnant. Additionally, you may be referred to a genetic counselor for help in assessing the risks of birth defects.

Also, women with epilepsy are more prone to vaginal bleeding and high blood pressure during pregnancy, as well as an increased risk for early labor and delivery.

It's important to be in good general health before pregnancy, if possible. Getting adequate rest, exercise and nutrition are essential. Your health care professional will advise you to take vitamins and folic acid (400 micrograms per day is recommended for women who are planning to become pregnant or who may become pregnant) prior to conception to reduce the risk of birth defects affecting the fetal spinal column. Many physicians recommend that folic acid supplementation begin with the first prescription for an antiepileptic drug because many pregnancies are not planned, and folic acid is most important in the first 28 days of fetal life. Folic acid is also important for many other biological processes. You may also need to take vitamin K supplements after you reach 34 weeks of pregnancy to reduce the risk of a blood-clotting disorder in infants called neonatal coagulopathy that can result from fetal exposure to certain epilepsy medications.

After birth, most mothers can safely breastfeed. Only minor amounts of epilepsy medications get excreted into breast milk, much less than the baby was exposed to in the womb and usually not enough to cause harm. Rarely, the baby may become drowsy and not feed properly; if so, these symptoms should be monitored carefully. Overall, most experts believe the benefits of breastfeeding outweigh the risks in women with epilepsy. Ask your health care professional about your options.

Becoming Seizure-Free

Although there is no cure for epilepsy, there is a chance you could become seizure-free. Some health care professionals will advise patients to discontinue medication after one to two years without a seizure while others advise waiting up to five years. Don't discontinue medication without advice from your health care professional.

You are less likely to remain seizure-free after discontinuing medication if your seizures gave been difficult to control; you have abnormal imaging studies; you need a combination of medications; you have other neurological problems in addition to epilepsy; or you have abnormal EEG results while on medication.

Surgery

When seizures cannot be controlled by medications, surgery may be an option. Approximately 15 percent of adults with epilepsy are candidates for curative brain surgery. Surgery is most commonly used to treat partial epilepsy. Other types of seizures that are treated with surgery include seizures that begin as partial seizures before spreading to the rest of the brain and unilateral multifocal epilepsy with infantile hemiplegia (such as Rasmussen's encephalitis).

Four basic types of surgery include:

• Temporal lobectomy. Appropriate for partial seizures that originate in the right or left temporal lobe area of the brain, this procedure involves removing the seizure-producing area and is the most effective form of surgery for epilepsy.

• Corpus callosotomy. In this procedure the network of neural connections between the right and left sides of the brain (hemispheres) are severed. This procedure won't stop seizures entirely, but it interrupts the spread of seizures across the whole brain as in generalized seizures. People who experience uncontrolled generalized seizures, drop attacks or massive movement disorders are good candidates for corpus callosotomy.

• Hemispherectomy. This is a more radical approach in which an entire side of the brain is removed or functionally disconnected from the other side. This procedure is a last resort, usually reserved for children under the age of 13 because the brain is capable of taking over some of the lost functions, and many children can recover fully.

• Multiple subpial transaction. If you experience seizures that originate in parts of the brain that control movement or language, removal of these areas would lead to paralysis or loss of language. Rather than removing those areas, multiple subpial transection is used to make small incisions in the brain, which interfere with the spread of seizure impulses.

Surgery for epilepsy should be performed only at specialized epilepsy centers, most of which are university-based. There are risks associated with any surgery, and there is no guarantee that seizures will be eliminated. Direct risks of brain surgery include cognitive or personality changes. Even after surgery, your health care professional may recommend that you continue to take antiepileptic drugs for at least two years or indefinitely depending on your type of epilepsy.

Vagus Nerve Stimulation

When medication fails to stop seizures, vagus nerve stimulation may be appropriate for adults and children 12 and older. This therapy administers small pulses of electrical energy to the brain via a battery-powered device that's implanted in the chest like a pacemaker. Thin wires are threaded under the skin and attached to the vagus nerve in the lower neck. If a person feels a seizure coming on, he or she can activate the discharge by passing a magnet over the device or it can be programmed to deliver small bursts of electrical stimulation every few minutes.

Complete seizure control is rarely achieved, so antiepileptic medication is usually prescribed with vagus nerve stimulation therapy. Side effects of therapy may include hoarseness or discomfort in the throat. Approximately one-third of those treated with vagus nerve stimulation experience a major improvement in seizure control. One-third have some relief, and one-third see no change.

New devices that deliver electrical stimulation directly to the brain are currently in testing and may provide attractive treatment options in the future.

Ketogenic Diet

This high-fat, low-carbohydrate diet has been and remains controversial. This diet causes the body to break down fats instead of carbohydrates to survive. It creates a condition in your body called ketosis. Some researchers believe that byproducts of ketosis inhibit seizures.

The ketogenic diet is not easy to maintain, and possible side effects include retarded growth due to nutritional deficiency and kidney stones due to build up of uric acid in the blood. If it's not strictly followed—even a few cookie crumbs or toothpaste can negate the effects—it won't work.

This diet is usually reserved for children under age 12 (but is being tried more in adults now) who don't respond well to medications. This therapy must be guided by a dietitian and supplemented with sugar-free vitamins and minerals. The diet is typically started in a hospital so you can be closely monitored for the first few days.

Coping With Epilepsy

Many women with epilepsy live relatively normal lives. However, the challenges presented by epilepsy can be overwhelming. According to a study conducted by the International Bureau for Epilepsy and a group of epileptologists, fear and uncertainty about seizure occurrence ranked as the worst aspect of living with the disorder. Like other chronic conditions, epilepsy can cause enormous stress, which in turn can lead to depression and other health issues for both you and your family.

Having epilepsy can affect your sense of independence, self-esteem, sexuality, personal relationships and just about every aspect of daily life. For example, most states won't issue drivers license unless you can document that you've gone a specific period of time without a seizure.

Consider taking these steps to help manage the challenges epilepsy presents:

• Join a support group online or in-person to learn how others with epilepsy cope.

• Take one day at a time.

• Learn as much as you can about the disorder and your treatment options.

• Be aware of any seizure triggers you may have and avoid them, if possible. Seizures can be triggered by a variety of things including lack of sleep, alcohol, stress and stimulating environments that involve fast eye movements—such as flashing holiday lights—or situations that cause dizziness, such as some amusement park rides.

• Don't withdraw. Stay active to fight depression, which is common in people with epilepsy for reasons researchers don't completely understand. If you are depressed, seek help. There are antidepressant medications that can work with your antiepileptic drugs to help you feel better.

• Make sure you get enough sleep, eat a balanced diet and exercise regularly. It's been shown that exercise can improve seizure control in some people. Ask your health care professional which activities are right for you.

• Be honest with those around you about your condition and help educate them to combat any misconceptions they might have about epilepsy.

• Ask for help, if you need it.

• Discuss any sexual problems you may have with your health care professional. Seizure medications can affect hormone levels and may reduce your sex drive, affecting intimate relationships.

The Americans with Disabilities Act makes it unlawful for employers to discriminate against people with epilepsy. It's against the law to fire or refuse to hire you because of your condition, except in extraordinary cases where seizures would make it impossible for you to do your job and some other position cannot be provided for you. If you suspect that you or someone you know with epilepsy has been discriminated against, contact the U.S. Equal Employment Opportunity Commission (EEOC) for support or information; call 1-800-669-4000 or check out www.eeoc.gov.

What To Do During A Seizure

Help others learn more about epilepsy and what to do when someone experiences a seizure. The Epilepsy Foundation recommends the following steps if you see someone having a seizure with convulsions or loss of consciousness:

• Roll the person on his or her side to prevent choking on any fluids or vomit.

• Cushion the person's head.

• Loosen any tight clothing around the neck.

• Do not restrict the person from moving unless he or she is in danger.

• Do not put anything in the person's mouth or attempt to force his or her mouth open with your figures. This could cause choking or damage to the person's jaw, tongue or teeth. Contrary to widespread belief, people cannot swallow their tongues during a seizure or any other time.

• Remove any sharp or solid objects that the person might hit during the seizure.

• Note how long the seizure lasts (if possible, time it with your watch) and what symptoms occurred so you can tell a health care professional or emergency personnel if necessary.

• Stay with the person until the seizure ends.

• After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Be patient and try to help him or her find a place to rest, if desired. If necessary, call a taxi, a friend or a relative to help the person get home safely.

Call 911 if:

• The person is pregnant or has diabetes.

• The seizure happened in water.

• The seizure lasts longer than five minutes.

• The person does not begin breathing again and return to consciousness after the seizure stops.

• Another seizure starts before the person regains consciousness.

• The person injures himself or herself during the seizure.

• This is a first seizure or you think it might be. If in doubt, check to see if the person has a medical identification card or jewelry stating that he or she has epilepsy or a seizure disorder.

If you see someone having a non-convulsive seizure (staring, automatic or purposeless actions or mumbling nonsensically), remember that the person's behavior is not intentional. The person may wander aimlessly or make alarming or unusual gestures. You can help by following these guidelines:

• Remove any dangerous objects from the area around the person or in his or her path.

• Don't try to stop the person from wandering unless he or she is in danger.

• Don't shake the person or shout.

• Stay with the person until he or she is completely alert.