With medications, “brain pacemakers,” CBD, and dietary changes, most people find relief.
A diagnosis of epilepsy can feel unnerving: You might be intimidated by the thought of having seizures at any given moment, or be afraid of how it will affect your life, your job, or your relationships.
“The good news is most people with epilepsy can be treated with medications,” says Padmaja Kandula, MD, neurologist at Weill Cornell Medicine and NewYork-Presbyterian. Patients can choose from a number of FDA-approved treatment options that have proved to be effective.
Medications to Treat Epilepsy
“Medication or drug selection [for epilepsy] is a little bit of an art form,” says Dr. Kandula. Medications must serve two purposes: to reduce the number and severity of seizures.
The right medication for an individual with epilepsy also depends on whether they experience focal seizures (which affect one part of the brain) or generalized seizures (which affect multiple areas on both sides of the brain).
With these epilepsy variations in mind, here are the common medication options for epilepsy:
Barbiturates allow negative chloride ions into channels, which calm the neuron activity to prevent seizures. These are an older type of medication that has a tranquilizing effect, thus causing sedative side effects that some may find unpleasant.
GABA drugs inhibit the GABA (gamma amino butyric acid) system to calm the neuron activity. GABA is a neurotransmitter in the brain that can inhibit the excitability of neurons. This is a newer type of medication that has fewer side effects than barbiturates.
Sodium channel blockers reduce the amount of sodium entering neurons, which might contribute to seizure activity for some people.
Surgery + Implantable Devices to Treat Epilepsy
Unfortunately, about a third of people with epilepsy do not find relief (or experience unwanted side effects) from typical epilepsy medications. For these people, a therapy known as neuromodulation uses a surgically implanted device to send small electric currents to the nervous system, which may help reduce seizures.
There are two approaches to neuromodulation:
Vagus nerve stimulation (VNS) is when surgeons implant a small device under the skin near the chest, which has a wire that is wrapped around the vagus nerve in the neck. This is typically used for people who experience focal seizures who have not been responsive to medications.
Responsive neurostimulation (RNS) gets its name because it constantly monitors brain waves and responds within milliseconds when activity seems unusual. It reacts by providing small pulses of stimulation to prevent or control the seizure before it happens. (By contrast, VNS sends regular, consistent pulses of electrical activity.)
Neuromodulation is “kind of like a brain pacemaker, similar to a cardiac pacemaker, that can interrupt nerve signals and can interrupt a seizure,” says Dr. Kandula.
Alternatively, another surgical option is to remove the part of the brain where seizures are occurring, which may reduce the likelihood of seizures or stop them altogether.
Alternative + Complementary Options to Treat Epilepsy
“People can use add-on dietary treatments in some cases,” says Dr. Kandula. In fact, you may have heard of a trendy weight-loss diet known as the “keto diet,” but this ketogenic diet was originally a therapeutic approach to helping kids with epilepsy.
The keto diet for epilepsy uses a severely low-carb approach in order to put the body into ketosis. This was used after researchers realized that fasting helped prevent seizures—but of course, no one can fast permanently. Since the body’s preferred energy is carbohydrates, a ketogenic diet mimics a fasting state by depriving the body of carbs while still getting calories and other nutrients.
“[If] any individual wants to use diets to treat any kind of medical condition, it should definitely be done under the guidance of a medical professional, and preferably a nutritionist if possible,” says Dr. Kandula.
Additionally, you may have heard about the FDA approval of high-dose prescription cannabidiol (CBD) to reduce seizures in children with epilepsy. CBD is an active component of cannabis that does not have psychoactive effects, which makes it ideal for children. (Note: The medication approved for epilepsy is different from typical CBD you can buy over the counter—it must be prescribed by a doctor.) Learn more about what CBD is here.
Ideally, each patient will find a single medication that is effective for them which can prevent seizures without causing disruptive side effects “in order for the person to function very well and do their day-to-day activities,” says Dr. Kandula. “That’s the goal of treatment.”
Dr. Kandula is a neurologist specializing in seizures and epilepsy at Weill Cornell Medicine and NewYork-Presbyterian in New York City.
00:00:02,363 --> 00:00:06,650
The good news is most people with
epilepsy can be treated with medications.
00:00:06,650 --> 00:00:10,922
And there are so many food and drug
administered medications that are approved
00:00:10,922 --> 00:00:12,936
in the United States and worldwide.
00:00:12,936 --> 00:00:18,663
00:00:18,663 --> 00:00:23,210
Medication or drug selection is
a little bit of an art form.
00:00:23,210 --> 00:00:24,920
They're two-fold purpose.
00:00:24,920 --> 00:00:29,881
One is to totally reduce the amount
of seizures if possible, and two,
00:00:29,881 --> 00:00:31,822
also reduce the severity.
00:00:31,822 --> 00:00:36,760
Depending on which seizure type, broadly
if it starts in one area or multiple areas
00:00:36,760 --> 00:00:41,357
at the same time, we can determine which
class of drugs might be beneficial.
00:00:41,357 --> 00:00:44,778
There are a lot of different kinds
of medications over the years.
00:00:44,778 --> 00:00:49,834
One class of drugs that's quite
old are called the barbiturates.
00:00:49,834 --> 00:00:51,883
And they're more like tranquilizers,
00:00:51,883 --> 00:00:56,050
which makes it a little bit tough in terms
of a side effect of being tired or sleepy.
00:00:56,050 --> 00:00:59,935
Newer medications continue to come
out with better side effect profiles.
00:00:59,935 --> 00:01:05,249
GABA drugs that can inhibit
transmitters that produce seizures.
00:01:05,249 --> 00:01:10,160
What we call sodium channel drugs,
and what they do is block the sodium
00:01:10,160 --> 00:01:14,416
channel in the body that might
be contributing to seizures.
00:01:14,416 --> 00:01:19,364
About a third of individuals were
medications and combination do not work,
00:01:19,364 --> 00:01:23,537
there are devices that can be put
in the brain, inside the head or
00:01:23,537 --> 00:01:24,945
00:01:24,945 --> 00:01:29,932
Like a brain pacemaker,
similar to a cardiac pacemaker that can
00:01:29,932 --> 00:01:33,915
interrupt nerve signals and
interrupt a seizure.
00:01:33,915 --> 00:01:37,659
In some cases,
if there's a select area that can be taken
00:01:37,659 --> 00:01:41,639
out of the brain that can also
reduce the number of seizures.
00:01:41,639 --> 00:01:44,045
And in many cases,
make someone seizure-free.
00:01:44,045 --> 00:01:48,375
People can use add-on dietary
treatments in some cases.
00:01:48,375 --> 00:01:51,160
The whole idea behind the ketogenic diet,
00:01:51,160 --> 00:01:54,981
a version of these diets is that
we use low amounts of glucose.
00:01:54,981 --> 00:01:57,634
And we put the body in
a state called ketosis, and
00:01:57,634 --> 00:01:59,660
that can help with seizure control.
00:01:59,660 --> 00:02:03,729
Any individual who wants to use diets
to treat any kind of medical condition,
00:02:03,729 --> 00:02:07,748
it should definitely be done under
the guidance of a medical professional.
00:02:07,748 --> 00:02:10,676
And preferably a nutritionist if possible.
00:02:10,676 --> 00:02:13,330
New to the market is
00:02:13,330 --> 00:02:16,500
It's FDA-approved in
a very select population.
00:02:16,500 --> 00:02:17,490
Right now, it's approved for
00:02:17,490 --> 00:02:21,420
pediatric patients with very
00:02:21,420 --> 00:02:25,020
We try to treat every patient
with one medication, and
00:02:25,020 --> 00:02:29,450
the least amount of medication in order
for the person to function very well.
00:02:29,450 --> 00:02:31,320
And do their day-to-day activities.
00:02:31,320 --> 00:02:32,212
That's the goal of treatment.
00:02:32,212 --> 00:02:36,372
GABA receptors in status epilepticus. Landover, MD: Epilepsy Foundation. (Accessed on November 21, 2019 at https://www.epilepsy.com/article/2018/2/gaba-receptors-status-epilepticus.)
Patient education: seizures in adults (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on November 21, 2019 at https://www.uptodate.com/contents/seizures-in-adults-beyond-the-basics.)
Responsive neurostimulation (RNS). Landover, MD: Epilepsy Foundation. (Accessed on November 21, 2019 at https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/responsive-neurostimulation-rns.)
Vagus nerve stimulation (VNS). Landover, MD: Epilepsy Foundation. (Accessed on November 21, 2019 at https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns.)