Treating epilepsy with anticonvulsants

Once diagnosed, your initial treatment will usually involve taking anticonvulsants, which are effective in many people, even at low doses. Side effects of these vary, but drowsiness and dizziness are common. In most people, the side effects are minor, provided the dose is minimal. The drugs may, however, interfere with the actions of other drugs and some are not suitable if you are pregnant, planning to become pregnant, breastfeeding, or have kidney or liver problems.

New anti-epileptic drugs are being developed all the time. Levetiracetam (Keppra XR®) is one of the newer ones. Different drugs are used for different types of epilepsy and your treatment.
About 50% of people who take medication have no seizures during a 5-year period and many then consider coming off medication. About 30% have fewer seizures. Medication doesn’t provide benefits in the remaining 20%.

Non-drug treatments for epilepsy

Other treatments include vagus nerve simulation (VNS), ketogenic diet, and surgery:

  • VNS:
    This involves electrical stimulation of the left vagus nerve at a point in the neck. It requires an implant under the skin. It is associated with fewer adverse reactions than medication, and relieves symptoms in some people.
  • Ketogenic diet:
    This is a high fat, low-carbohydrate diet. It is mainly used with children. Research suggests the diet reduces frequency of seizures in about 50% of children. There are concerns about its applicability to all types of patients and its impact on general health; it is also uncertain how long people should remain on it.
  • Surgery:
    Some surgery that aims to correct another problem, to remove a tumour for instance, may also relieve epilepsy. Other surgery aims to remove the specific cause of the epilepsy if it can be identified. This is sometimes the case in temporal lobe epilepsy; removing part of the temporal lobe can change the frequency of seizures. Surgery to sever the corpus callosum, the tissue that connects the two cerebral hemispheres, is sometimes advised. The most extreme surgical treatment is to remove the entire cerebral hemisphere but is only done as a last resort in someone with very severe epilepsy that fails to respond to other treatments. The risk of paralysis is very high, and this needs to be weighed against the problems created by continuing seizures.