If you or a loved one has epilepsy, the goal is clear: reduce seizures with the fewest side effects. Treatment starts with the right diagnosis. A neurologist will ask about seizure details, order an EEG to watch brain activity, and usually get an MRI to check for structural causes. Accurate diagnosis steers the rest of the plan.
Common medications are effective for most people. First-line drugs include levetiracetam, lamotrigine, carbamazepine, and valproate. Each drug targets different seizure types and has its own side effects. Levetiracetam often causes mood changes in some people. Lamotrigine needs slow dose increases to avoid rash. Carbamazepine can affect sodium levels and liver tests. Valproate works for many seizure types but is risky in pregnancy. Your doctor will pick a drug based on seizure type, age, sex, other health issues, and other medicines you take.
How long should treatment last? That depends. Many adults who have been seizure-free for two to five years may discuss tapering medication with their doctor. Stopping drugs carries a seizure recurrence risk, so tapering should be gradual and supervised. Never stop suddenly.
Not all cases respond to drugs. If seizures continue after two appropriate medications, mention "drug-resistant epilepsy." Options then include surgery, vagus nerve stimulation, responsive neurostimulation, or diet therapy. Surgery can remove a small area causing seizures and can be curative for some people. Vagus nerve stimulation and responsive devices help reduce seizure frequency. The ketogenic diet, a high-fat low-carbohydrate plan, can cut seizures for children and some adults when done with medical support.
Safety and daily life matter. Wear a medical ID if your seizures cause loss of awareness. Avoid swimming alone and protect against heights when needed. Learn simple seizure first aid: cushion the head, turn someone onto their side if breathing normally, time the seizure, and call emergency services if it lasts longer than five minutes or repeats without recovery. Don’t force anything into the mouth.
Pregnancy and epilepsy need planning. Some medications increase birth defect risks, so women should talk to their neurologist before conceiving. Folic acid supplements are often recommended. Blood tests help monitor levels for drugs like phenytoin or carbamazepine during pregnancy.
Keep a seizure diary. Note triggers, sleep, stress, and missed doses. This helps your doctor fine-tune treatment. If side effects become a problem, speak up; there are alternatives and strategies to manage them.
Finding the right care matters. Ask for referrals to epilepsy centers if seizures are hard to control. A second opinion can open new options. With the right approach, many people with epilepsy can work, drive, and live full lives.
Call emergency services if a seizure lasts more than five minutes, if breathing doesn't resume quickly, if repeated seizures occur without recovery between them, or if injury or pregnancy is involved.
Look for a neurologist trained in epilepsy. Ask about surgery experience, EEG access, and if the center offers diet therapy and device options.
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