Epilepsy doctors will recommend a treatment plan. The goal: to keep a person from having seizures with few or no side effects.

Medicines

Epilepsy is usually treated with seizure-preventing medicine. There are more than 20 medicines for epilepsy; they may have to be taken several times a day, or once or twice a day, depending on the type of drug.

Whenever possible, doctors try to prevent seizures with a single medication (monotherapy), although some people may need more than one medication (polytherapy) to achieve seizure control.

In selecting a drug, the doctor considers a number of factors, including what kind of seizures the person has. Different medicines control different types of seizures.

People also react to medicines in different ways. Some have side effects; others may not. Some people's seizures respond well to a medicine, while someone else will have seizures that come back. It may take some time to find exactly the right dose of the right medicine.

Taking medicine on time every day keeps the right amount of medicine in the bloodstream to fight seizures. It's not a good idea to miss doses. If the level of drug in the bloodstream gets too low, the seizures may come back.

What about side effects? All medicines can cause them. Some go away once the person gets used to the meds. Some depend on how much has to be taken to prevent seizures. Some people have allergic reactions to medicines that others can take without difficulty.

One or more of the following medicines may be prescribed for daily use to prevent seizures. Other drugs not listed here may also be prescribed. The first name listed is the generic or family name of the medication, the second name in parentheses is the brand name or names.

Carbamazepine (Tegretol, Tegretol XR, Carbatrol); clonazepam (Klonopin); ethosuximide (Zarontin); felbamate (Felbatol), lamotrigine (Lamictal); levetiracetam (Keppra), oxcarbazepine (Trileptal); phenobarbital; phenytoin (Dilantin, Phenytek); primidone (Mysoline); tiagabine (Gabitril); valproate (Depakote, Depakene); zonisamide (Zonegran).

Other epilepsy medicines are used during a seizure to bring it to an end. Rectal diazepam gel (Diastat) may be prescribed for home use to stop clusters of seizures or prolonged seizures. Fosphenytoin (Cerebyx) is used in hospitals to stop episodes of status seizures.

If medicines are not effective, the person with epilepsy may want to find out about surgery, a special diet or vagus nerve stimulation (VNS), which are other ways to treat epilepsy.

Surgery

Brain surgery is usually considered when someone has:

• Already tried the medicines without success (or has bad reactions to them).
• Seizures that always start in just one part of the brain.
• Seizures in a part of the brain that can be removed without damaging speech, memory, eyesight or other key functions of the brain.

Surgery for epilepsy is a major, complex operation. It has to be done by a surgical team with special skills. Medical centers, not local hospitals handle epilepsy surgery.

While some operations remove the part of the brain where seizures start, other surgery is used to stop the spread of electrical energy through the brain. After surgery, seizure medicine may be continued, at least for a time.

Many people do well following surgery and become seizure free. Others continue to have some seizures. For some, surgery is not successful in controlling or reducing seizures

Ketogenic Diet

Children with difficult to control seizures may be put on a special diet to treat epilepsy. It's called the ketogenic diet and it tricks the body into burning fat, instead of sugar, for energy. About a third of children placed on it do very well; another third has fewer seizures, the remaining children do not benefit. The diet has been tried in some adults, with similar results.

The diet is high in fats. It causes a change in the body, called ketosis. This controls seizures, or results in less of them. A special team works with the ketogenic diet. Food has to be carefully calculated and weighed on a scale.

The ketogenic diet is a very strict diet. Even a few cookie crumbs can cancel its effects and cause seizures.

Vagus Nerve Stimulation (VNS)

Vagus nerve stimulation is another form of treatment that may be tried when medicine alone doesn't work. Although it is unlikely to make a person seizure-free, it has reduced seizures for many people. The VNS system consists of a small battery in the shape of a disc, which is surgically implanted under the skin on the chest wall. It can be programmed to send regular bursts of electrical energy through implanted electrode wires linked up to a large nerve in the neck. The stimulation is designed to prevent seizures.

When people who have the system feel a seizure coming on, they pass a small magnet over the battery. This releases a burst of energy that may stop or shorten the seizure. Most people with VNS continue to take medicine, but may be able to reduce how much they take.