Treatment

There is currently no cure for most types of epilepsy.

A doctor may prescribe antiepileptic drugs  to help prevent seizures. If these drugs do not work, some other potential options include surgery, vagus nerve stimulation, or a special diet.

Doctors’ objective is to prevent further seizures. They also aim to prevent side effects so that the person can lead an active and productive life.

It is important to note that some drugs may prevent seizures in one person but not in another. Also, even when a person finds the right drug, it may take some time to find the ideal dosage.

Surgery

If at least two medications have been ineffective in controlling seizures, a doctor may consider recommending epilepsy surgery.2013 study from Sweden found that 62% of adults and 50% of children with epilepsy had no seizures for around 7 years after epilepsy surgery.

According to the National Institute of Neurological Disorders and Stroke, some surgical options include:

  • Lobectomy: During this procedure, a surgeon will remove the section of the brain in which seizures start. This is the oldest type of epilepsy surgery.
  • Multiple subpial transection: During this procedure, a surgeon will make several cuts to limit seizures to one part of the brain.
  • Corpus callosotomy: A surgeon will cut the neural connections between the two halves of the brain. This prevents seizures from spreading from one side of the brain to the other.
  • Hemispherectomy: In extreme cases, a surgeon may need to cut out a hemisphere, which is one half of the cerebral cortex of the brain.

For some people, undergoing surgery may reduce the frequency and severity of their seizures. However, it is often important to continue taking antiseizure medication for several years following the procedure.

Another surgical option is the implantation of a device in the chest to stimulate the vagus nerve in the lower neck. The device sends preprogrammed electrical stimulation to the brain to help reduce seizures.

Diet

Diet may play a role in reducing seizures. A 2014 review of research that appeared in the journal Neurology suggested that high fat, low carbohydrate diets could benefit children and adults with epilepsy.

Five of the studies in the review used the ketogenic diet, while another five used a modified Atkins diet. Typical foods in these diets include eggs, bacon, avocados, cheese, nuts, fish, and certain fruits and vegetables.

The review found that 32% of study participants adhering to the ketogenic diet and 29% of those following the modified Atkins diet experienced at least a 50% drop in the regularity of seizures. However, many participants had difficulty maintaining these diets.

Specific diets may be beneficial in some cases, but more research is needed to confirm this.

 

Diagnosis

A doctor will review an individual’s medical history and the symptoms they have experienced, including a description and timeline of past seizures, to diagnose epilepsy.

They may also request tests to determine the type of epilepsy and the type of seizures the person has. Based on these results, the doctor will be able to recommend treatment options, such as antiseizure medications.

Testing for epilepsy

a girl having an EEG to test for epilepsy
An EEG can help doctors test for epilepsy.

Several types of imaging test can help a doctor diagnose epilepsy. These tests include:

  • an EEG, to look for abnormal brain waves
  • CT and MRI scans, to detect tumors or other structural irregularities
  • functional MRI scans, which can identify normal and abnormal brain function in specific areas
  • single-photon emission CT scans, which may be able to find the original site of a seizure in the brain
  • a magnetoencephalogram, which can identify irregularities in brain function using magnetic signals

The doctor may also use blood tests to identify any underlying conditions that could be causing the epilepsy. Neurological tests may also help a doctor determine the type of epilepsy the person has.

Seizures can lead to drowning, falling, vehicle accidents, or other injuries that could be fatal. Although it is rare, SUDEP can also occur.

Cases of SUDEP typically occur during a seizure or immediately after it. For example, the seizure may cause the person to go too long without breathing, or it could result in heart failure.

The exact cause of SUDEP is unclear,

According to the CDC, people are at more risk of SUDEP if they have had epilepsy for many years, or if they have regular seizures. Following these steps can help reduce the risk of SUDEP:

  • taking all doses of antiseizure medication
  • limiting alcohol intake
  • getting sufficient sleep

Regularly taking prescribed medication may also help prevent status epilepticus, a condition wherein seizures last for longer than 5 minutes.

2016 study found that treating status epilepticus within 30 minutes reduced the risk of death.

Is it curable?

There is currently no cure for epilepsy, but people with the condition can usually manage their symptoms.

According to the WHO, up to 70% of people with epilepsy can experience a reduction in their seizure frequency and severity with antiseizure medications. Around half of all people with epilepsy may be able to stop taking medications after 2 years without a seizure.

In some cases, surgery can also reduce or eliminate seizures when drugs are ineffective.

This can have long-term benefits. In one 2018 study, 47% of the participants reported no debilitating seizures 5 years after surgery, and 38% reported the same after 10 years.

Prevention

The WHO explain that around 25% of epilepsy cases are preventable. People can reduce the risk of developing epilepsy by following these steps:

wearing a helmet when riding a bicycle or motorcycle, to help prevent head injuries

seeking perinatal care, to prevent epilepsy from birth injuries

managing risk factors for stroke and heart disease, which could cause brain damage that results in epilepsy

practicing good hygiene and preventative methods to avoid cysticercosis, an infection that is the most common cause of epilepsy around the world, according to the CDC.

A 2015 review of research in the journal Seizure also suggested that regular physical activity may help prevent the development of epilepsy and reduce how often seizures occur.

It is not possible to prevent all cases of epilepsy. However, taking the above steps may help reduce the risk.

Complications

Depending on the situation, seizures may lead to negative outcomes such as drowning or vehicle accidents. Long lasting seizures, or status epilepticus, may also cause brain damage or death.

People with epilepsy are eight times more likely than people without it to experience certain other chronic conditions, including dementia, migraine, heart disease, and depression. Some of these conditions could also make seizures worse.

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