Treatment options Dr Matthew Walker While drugs are the usual form of treatment for epilepsy, surgical techniques are becoming more sophisticated. Complementary therapies can be used, but can't replace medical treatments. Here we look at the options.

In this article

Medication Surgical treatment

Complementary treatments Outcome of treatments

Chance of a cure?

Once epilepsy has been diagnosed and the doctor has discussed this with the patients, an anti-epileptic drug (AED) will be prescribed to prevent further seizures.

The choice of drugs depends on the patient and the type of epilepsy they have. The initial dose will be low and gradually increased until the seizures stop.

Sometimes patients can experience side effects, especially with higher doses of drugs. The most common are drowsiness, unsteadiness and dizziness. Rare allergic reactions to some drugs can include rashes and various blood disorders. There may also be longer term side effects such as weight gain and acne.

If there are side effects or the seizures don't stop, the doctor will try another drug. In most cases it's possible to stop the seizures with minimal or no side effects.

For the AEDs to work, the patient has to take them continuously. Not taking drugs as instructed (what doctors call "poor compliance") is a major cause of AED failure.

Suddenly stopping AEDs can cause prolonged, severe seizures. Withdrawal of drug therapy must, therefore, take place gradually.

Many AEDs interact with other drugs, so care has to be taken when starting other medication (for example, antibiotics or painkillers). Many also make the contraceptive pill less effective, so if you're on the pill you must discuss this with your doctor.

For those whose epilepsy doesn't respond to AEDs, surgical treatment is sometimes appropriate.

The assessment for surgery is complex and involves:

• Identifying a local brain abnormality that can be removed.
• Confirmation that the seizures are indeed originating from the abnormality.
• Confirmation that removal of the abnormality won't cause unacceptable side effects (for example, stroke, memory and speech problems).

The most usual curative surgery is the removal of a scarred hippocampus, as this is a common cause of epilepsy that's resistant to drugs. (The hippocampus is a part of the brain involved in memory and is very susceptible to damage.)

Sometimes neurosurgery is used not to cure the epilepsy but simply to reduce the severity or frequency of the seizures by making it more difficult for the seizures to spread.

Vagal nerve stimulation is a form of surgical treatment that doesn't involve an operation on the brain. Instead, a stimulator (pace-maker) is placed under the skin and stimulates the vagus nerve in the neck. This is a major nerve that runs from the abdomen to the brain and controls many functions. This form of treatment doesn't usually cure the epilepsy but can reduce seizure frequency and severity.

There are a number of proposed alternative and complementary treatments for epilepsy. These should not be used as alternatives to conventional treatments, but in addition to them. None has been shown conclusively to work.

• Relaxation therapies - epilepsy can worsen at times of stress so there's some evidence to suggest that yoga and aromatherapy can help.
• Herbal remedies - these should be used with caution, as some can interact with anti-epileptic drugs.
• Acupuncture and homeopathy - although there's no definite evidence these treatments work, some patients do benefit from them.

AEDs are very effective: three-quarters of those treated with such drugs will have their seizures completely controlled. Even those whose seizures don't completely respond usually gain some benefit, and newer AEDs are being developed that offer people with drug-resistant epilepsy hope for improvement.

More than half the people who have their seizures completely controlled with AEDs are able to come off treatment without a recurrence of their seizures.

Surgery is only an option for a minority of people with drug-resistant epilepsy, but in those with scarring of the hippocampus, surgery offers a 60 to 70 per cent chance of a cure.

Doctors are continuing to identify more and more underlying causes of epilepsy in patients whose epilepsy is resistant to drugs and, with improved surgical techniques, it's becoming increasingly possible to cure epilepsy through neurosurgery.

For patients who aren't suitable for such surgery, the pace of research and the development of more effective AEDs is such that the future looks rosy.

Other experimental, but potentially valuable, approaches have been advances in brain stimulation and the possibility of injecting very young cells (stem cells) into the brain to repair damaged brain tissue.

This article was last medically reviewed by Dr Rob Hicks in October 2006.
First published in May 2002.