Treatment for epilepsy is used to control seizures, although not everyone with the condition will need to be treated.
It may sometimes be possible to control your epilepsy solely by avoiding things that trigger your seizures, such as sleep deprivation and alcohol.
While some people may need to be treated for the rest of their lives, this is not always the case. Sometimes people have epileptic seizures at one stage in their life, only for them to become less frequent or disappear as they get older. This is more common if seizures first occur in childhood or early adulthood.
Anti-epileptic drugs (AEDs) are usually the first choice of treatment for epilepsy. About 70% of people with the condition are able to control their seizures with AEDs.
Usually, AED treatment will not begin until after you have had a second seizure because a single seizure is not necessarily a reliable indicator that you have epilepsy.
In some cases, treatment may begin after a first seizure if:
an electroencephalogram (EEG) shows brain activity associated with epilepsy
a magnetic resonance imaging (MRI) scan shows damage to the brain
you have a condition that has damaged the brain, such as a stroke
For some people, brain surgery may be an option. However, this is only the case if removing the area of the brain where epileptic activity starts would not cause damage or disability. If successful, there is a chance your epilepsy will be cured.
If surgery is not an option, an alternative may be to implant a small device under the skin of the chest. The device sends electrical messages to the brain. This is called vagus nerve stimulation.
Sometimes, a special diet is used for children whose seizures are difficult to control and do not respond to treatment with medication.
Anti-epileptic drugs (AEDs)
Most people with epilepsy can be successfully treated with AEDs. AEDs do not cure epilepsy, but can prevent seizures from occurring.
There are many different AEDs. Generally, they work by changing the levels of the chemicals in your brain that conduct electrical impulses. This reduces the chance of a seizure.
The type of AED recommended for you will depend on a number of factors, including the type of seizures you have, your age, whether there are any concerns about a certain AED interacting with other medicines (such as the contraceptive pill), and whether you are thinking of having a baby.
Examples of commonly used AEDs include sodium valproate, carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, ethosuximide and topiramate.
AEDs are available in a number of different forms, including tablets, capsules, liquids and syrups.
It is important you follow any advice about when to take AEDs and how much to take. Never suddenly stop taking an AED because doing so could cause a seizure.
Your specialist will start you on a low dose of an AED, then gradually increase it within safe limits until your seizures stop, or if you develop side-effects. If one AED does not control seizures, another will be tried by gradually introducing the new medication and slowly reducing the dose of the old one.
The aim is to achieve maximum seizure control with minimum side effects, using the lowest possible dose of a single medicine. Trying a different type of AED is preferable to taking more than one AED, although a combination of medicines may sometimes be necessary to control seizures.
While taking AEDs, do not take any other medicines, including over-the-counter medicines or complementary medicines such as St John’s Wort, without first speaking to your GP or epilepsy specialist. Other medicines could have a dangerous interaction with your AED and cause a seizure.
Sodium valproate is not usually prescribed for women of childbearing age because there is a risk it could cause physical defects or developmental problems in an unborn baby.
It can be used if there is no alternative, or if your specialist has assessed you and it’s unlikely you’ll respond to or tolerate other treatments. Your specialist or GP will also need to check you are using a reliable form of contraception.
If you do not have a seizure for more than two years, it may be possible to stop taking your AEDs. Your epilepsy specialist can discuss with you whether this is appropriate and the best way this can be done.
Side effects are common when starting treatment with AEDs. However, they are usually short-lived and pass in a few days.
The specific side affects you may experience will depend on the medication you are taking, but general common side effects of AEDs include:
- a lack of energy
- uncontrollable shaking (tremor)
- hair loss or unwanted hair growth
- swollen gums
If you develop a rash, this may mean that you are allergic to the medication. In this case seek medical advice right away.
Sometimes, you may experience symptoms similar to being drunk – such as unsteadiness, poor concentration and vomiting – if your dose is too high. Contact your GP or epilepsy specialist immediately if you experience these side effects so that your dose can be revised.
For information on the side effects of a particular AED, check the information leaflet that comes with your medication.
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