Treatment

Not everyone who has one seizure has another one. Because a seizure can be an isolated incident, your doctor may not start treatment until you've had more than one. Treatment usually involves the use of anti-seizure medications.

Medications

Many medications are used in the treatment of epilepsy and seizures, including:

• Carbamazepine (Carbatrol, Tegretol, others)
• Phenytoin (Dilantin, Phenytek)
• Valproic acid (Depakene)
• Oxcarbazepine (Oxtellar, Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Gralise, Neurontin)
• Topiramate (Topamax)
• Phenobarbital
• Zonisamide (Zonegran)

Finding the right medication and dosage can be challenging. Your doctor likely will first prescribe a single drug at a relatively low dosage, and then increase the dosage gradually until your seizures are well-controlled.

Many people with epilepsy are able to prevent seizures with just one drug, but others need more than one. If you've tried two or more single-drug regimens without success, your doctor may recommend trying a combination of two drugs.

To achieve the best seizure control possible, take medications exactly as prescribed. Always call your doctor before adding other prescription medications, over-the-counter drugs or herbal remedies. And never stop taking your medication without talking to your doctor.

Mild side effects of anti-seizure medications can include:

• Fatigue
• Dizziness
• Weight gain

More-troubling side effects that need to be brought to your doctor's attention immediately include:

• Mood disruption
• Skin rashes
• Loss of coordination
• Speech problems
• Extreme fatigue

In addition, the drug Lamictal has been linked to an increased risk of aseptic meningitis, an inflammation of the protective membranes that cover the brain and spinal cord that's similar to bacterial meningitis.

Surgery and other therapies

When anti-seizure medications aren't effective, other treatments may be an option:

• Surgery. The goal of surgery is to stop seizures from happening. Surgeons locate and remove the area of your brain where seizures begin. Surgery works best for people who have seizures that always originate in the same place in their brains.
• Vagus nerve stimulation. A device implanted underneath the skin of your chest stimulates the vagus nerve in your neck, sending signals to your brain that inhibit seizures. With vagus nerve stimulation, you may still need to take medication, but you may be able to lower the dose.
• Responsive neurostimulation. During responsive neurostimulation, a device implanted on the surface of your brain or within brain tissue can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure.
• Deep brain stimulation. Doctors implant electrodes within certain areas of your brain to produce electrical impulses that regulate abnormal brain activity. The electrodes attach to a pacemaker-like device placed under the skin of your chest, which controls the amount of stimulation produced.
• Dietary therapy. Following a diet that's high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, though less effective, aren't as restrictive as the ketogenic diet and may provide benefit.

Pregnancy and seizures

Women who've had previous seizures usually are able to have healthy pregnancies. Birth defects related to certain medications can sometimes occur.

In particular, valproic acid has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. It's especially important to avoid valproic acid during the first trimester of pregnancy, if possible.

Discuss these risks with your doctor. Because of the risk of birth defects, and because pregnancy can alter medication levels, preconception planning is particularly important for women who've had seizures.

In some cases, it may be appropriate to change the dose of seizure medication before or during pregnancy. Medications may be switched in rare cases.

Contraception and anti-seizure medications

It's also important to know that some anti-seizure medications can alter the effectiveness of oral contraceptives — a form of birth control — and some oral contraceptives can speed up the absorption of seizure medications. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.