Epilepsy treatment: practical options and what to expect

If you or someone close has epilepsy, the first goal is to stop seizures with the fewest side effects. Treatment usually starts with antiseizure medications (ASMs). Your neurologist will pick a drug based on the seizure type, age, other health problems, and possible drug interactions.

Common medications include levetiracetam, lamotrigine, carbamazepine, valproate and topiramate. Each drug has pros and cons. For example, levetiracetam is easy to use and causes fewer drug interactions, while valproate can be very effective for generalized seizures but has serious risks in pregnancy.

If meds don't control seizures, other options exist. Vagus nerve stimulation (VNS) sends mild pulses to the brain through a small device under the skin. It can reduce seizure frequency for many people. Responsive neurostimulation (RNS) is another implant that detects and stops seizures early. For the right patients, epilepsy surgery can remove the seizure focus and sometimes cure epilepsy.

Dietary therapy works well for some, especially children. The ketogenic diet is high fat, very low carb, and can cut seizures dramatically. Modified versions are easier to follow and still help. Always do dietary therapy with medical supervision to avoid nutrient gaps.

Lifestyle changes matter. Good sleep, regular meals, consistent meds, and avoiding known triggers lower seizure risk. Alcohol, missed doses, extreme stress, and sleep loss are common triggers. Keep a seizure diary to spot patterns and bring useful data to clinic visits.

Safety steps at home can reduce injury during a seizure. Make the environment safe—remove sharp edges, use non-slip mats, and avoid open flames when alone. Learn first aid: turn the person on their side, time the seizure, and call emergency services if it lasts more than five minutes or breathing stops.

When to see a specialist

See a neurologist if seizures continue after two well-chosen medications, if seizures start suddenly in adulthood, or if seizures affect daily life. A specialist can order EEG, MRI, and recommend surgery or devices.

Questions to ask your doctor

Ask about seizure type, realistic goals, side effects to expect, impact on driving and work, pregnancy planning, and how to manage missed doses. Also ask about support groups and local resources.

Driving and work rules vary by place. Tell your doctor if you drive and ask about local laws. Many regions require seizure-free periods before you can drive again. For work, plan for safety measures and let HR or a trusted coworker know what to do during a seizure.

Pregnancy needs special planning. Some ASMs raise risks to the fetus while uncontrolled seizures also pose risks. Talk to a neurologist and obstetrician before trying to conceive. Folic acid, dose adjustments, and careful monitoring often keep both mother and baby safer.

If you struggle with mood or memory, mention it—many treatments and support services can help these issues too. Ask often.