Treating Epilepsy: Options That Can Help Control Seizures

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.”

Padmaja Kandula, MD

This video features Padmaja Kandula, MD. Padmaja Kandula, MD, is a neurologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City.

Duration: 2:36. Last Updated On: Dec. 6, 2019, 2:10 p.m.
Reviewed by: Preeti Parikh, MD . Review date: Nov. 26, 2019
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