Treatment for Epilepsy

Antiepileptic drugs (AEDs) can prevent seizure activity by altering neurotransmitter activity in nerve cells, but cannot correct the underlying condition. Approximately 70 percent of patients successfully control seizures with medication. Nearly 50 percent of those require two drugs to be seizure free. Because medications interact, the drug regimen must be carefully designed to maximize the effectiveness and to avoid serious complications and side effects.

The goals of treatment are no seizures and no side effects. If possible, treatment should consist of one drug (called monotherapy). Seizure management is complicated when patients are given more than one drug. The patient may experience drug interactions, increased side effects, and other adverse reactions.

Compliance is essential. To control seizures, a constant level of medication must be maintained in the body. Antiepileptic drugs should not be discontinued abruptly because of the risk for triggering life-threatening status epilepticus.

Although, antiepileptic drugs may cause abnormal embryo development (i.e., have teratogenetic potential), most women with epilepsy require treatment to prevent seizures during pregnancy. To control seizures and minimize risk to the fetus, women should educate themselves about epilepsy and pregnancy prior to conception.

Ketogenic Diet to Treat Epilepsy

The ketogenic diet is used in children who do not respond to standard therapy or cannot tolerate the side effects produced by antepileptic drugs. The diet is a high-fat, low-carbohydrate diet that fundamentally changes the body's metabolism from using glucose as a primary energy source to using fats. Ketones are a type of lipid, or fat, that provides energy for skeletal muscle, the heart, kidneys, and the brain.

It is most effective in children 10 years of age and younger. Compliance, which is essential for controlling seizures, is difficult to maintain. The regimen often is initiated with fasting period (12-24 hours). Every meal includes exact amounts of fats, proteins, carbohydrates, and beverages, and only those foods listed for the diet can be eaten. Snacking is discouraged and sugars are not allowed. A vitamin and mineral supplement must be given.

The diet should be undertaken only with close medical supervision. Children must be monitored for growth and nutritional deficiencies. Common complications include poor growth and poor weight gain, high cholesterol (hypercholesterolemia), and constipation.

Seizure Management

Many patients believe that yoga, acupuncture, aromatherapy, biofeedback, behavior psychotherapy, and meditation can improve their quality of life. However, there is little scientific proof that these therapies are effective. Some of these therapies reduce stress, which decreases seizure activity in some patients.

Publication Review By: Gordon R. Kelley, M.D.

Published: 31 Jan 2002

Last Modified: 14 Sep 2015