Not everyone who has one seizure has another one. Because a seizure can be an isolated incident, you may not start treatment until you’ve had more than one. Treatment usually involves the use of anti-seizure medicines.
Medications
Many medicines are used in the treatment of epilepsy and seizures. These are usually taken daily by mouth to help prevent seizures. Different medicines may be prescribed based on factors such as your specific seizure type and how often you have them, and your personal considerations such as your age and whether or not you’re pregnant.
Finding the right medicine and dosage can be challenging. A healthcare professional likely will prescribe a single medicine at a relatively low dosage, then may increase the dosage gradually until your seizures are well controlled.
Many people with epilepsy are able to prevent seizures with just one medicine. But others need more than one. If you’ve tried two or more single-drug regimens without success, you may need to try a combination of medicines.
For the best seizure control possible, take medicines exactly as prescribed. Ask a healthcare professional before adding other medicines or stopping your medicine. This includes prescription medicines, medicines available without a prescription or herbal remedies.
Mild side effects of anti-seizure medicines can include:
- Fatigue.
- Dizziness.
- Weight gain.
More-troubling side effects need to be brought to the attention of a healthcare professional right away. They include:
- Mood changes.
- Skin rashes.
- Loss of coordination.
- Speech problems.
- Extreme fatigue.
- Swollen lymph nodes.
- Swelling of the face or eyes, or painful sores in the mouth or around the eyes.
- Trouble swallowing or breathing, including during exercise.
- Discoloration of the skin or eyes such as a yellowing.
- Bruising and bleeding that’s not typical.
- Fever and muscle pain.
In rare cases, the medicine lamotrigine has been linked to an increased risk of aseptic meningitis. Aseptic meningitis is an inflammation of the protective membranes that cover the brain and spinal cord. The disease is similar to bacterial meningitis but isn’t caused by bacteria.
The U.S. Food and Drug Administration has warned that two anti-seizure medicines can cause a serious reaction, although it happens rarely. Levetiracetam and clobazam can cause inflammation and symptoms that include a rash, fever, swollen lymph nodes, and swelling of the face or eyes. Without quick treatment, the reaction can lead to organ damage, including to the liver, kidneys, lungs, heart or pancreas. It also can lead to death.
These symptoms can begin 2 to 8 weeks after starting levetiracetam or clobazam, but symptoms also may occur earlier or later. Get emergency medical attention if you take these medicines and experience a reaction or any of these serious symptoms.
Talk to your healthcare professional before stopping these medicines. Suddenly stopping the medicines can cause seizures to return.
Surgery and other therapies
When anti-seizure medicines aren’t effective, other treatments may be an option:
- Surgery. The goal of surgery is to stop seizures from happening. It may be an option if you have tried two different medicines and they don’t prevent your seizures. Surgeons locate and remove the area of your brain where seizures begin. Surgery works best for people who have seizures that originate in the same place in their brains.
- Vagus nerve stimulation. A device placed underneath the skin of your chest stimulates the vagus nerve in your neck. This sends signals to your brain that stop seizures. With vagus nerve stimulation, you may still need to take medicine, 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. The device can deliver an electrical stimulation to the detected area to stop the seizure.
- Deep brain stimulation. For this therapy, a surgeon implants electrodes within certain areas of the brain. The electrodes produce electrical impulses that regulate brain activity. The electrodes attach to a pacemaker-like device placed under the skin of your chest. This device controls the amount of stimulation produced.
- Dietary therapy. A diet that’s high in fat and protein and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a ketogenic diet are less effective but may provide benefit. They include the low glycemic index diet and modified Atkins Diet.
Pregnancy and seizures
Women who’ve had previous seizures usually are able to have healthy pregnancies. Birth defects related to certain medicines 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 don’t use valproic acid during pregnancy because of risks to the baby.
You may want to talk about these risks with a healthcare professional. Planning before getting pregnant is particularly important for women who’ve had seizures. In addition to the risk of birth defects, pregnancy can alter medicine levels.
In some cases, it may be appropriate to change the dose of anti-seizure medicine before or during pregnancy. In rare cases, your healthcare professional may consider changing your medicines.
Contraception and anti-seizure medications
It’s also important to know that some anti-seizure medicines can make oral contraceptives — a form of birth control — less effective. Also, some oral contraceptives can speed up the metabolism of anti-seizure medicines. Check with a healthcare professional to evaluate whether your medicine interacts with your oral contraceptive. Ask if other forms of contraception need to be considered.
