Patient information from BMJ

Epilepsy: what treatments work?

Last published:Nov 28, 2019

Epilepsy is a serious condition that causes people to have seizures (fits). But there are medicines that work well to keep it under control. With treatment, most people get fewer seizures or none at all.

What treatments work?

If you or your child has epilepsy the normal electrical activity in the brain gets disturbed from time to time. This leads to seizures.

A seizure affects how your brain works. What happens to you during a seizure depends on the part of the brain that is affected. During a seizure you may feel strange and your body might move in odd ways. Your muscles may go limp or stiff, and you may shake, twitch, or black out. But seizures tend to be over quickly.

The usual treatment for epilepsy is taking medicines. Doctors usually wait for someone to have at least two seizures before they start treatment. Epilepsy medicines reduce or stop seizures for most people. Most epilepsy medicines have side effects. You’ll need to work with your doctor to find the medicine (or combination of medicines) that works best for you.

Medicines

The medicines used to prevent epileptic seizures are called anti-epileptic or anti-convulsant medicines. There are several available. Different ones work better for different people. You may need to try different ones to see which works best for you.

Most people with epilepsy can control their seizures with just one epilepsy medicine. The seizures may stop, be less severe, or happen less often.

About half of all people who take epilepsy medicines get some side effects. Common side effects include dizziness, nausea, skin rashes, exhaustion, and weight gain or weight loss.

Some of the drugs can cause different side effects, such as depression and temporary hair loss.

But, if you get side effects, your doctor may cut down the dose and wait two weeks before increasing it again. You may then find that the side effects stop. Or you might be able to switch to another medicine.

You should see your doctor immediately if you or your child gets a rash while taking any epilepsy medicines. Although the rash will probably go away, very rarely it can develop into a serious (and sometimes fatal) skin condition called Stevens-Johnson syndrome.

Epilepsy, pregnancy, and contraception

Women with epilepsy usually need to carry on taking epilepsy medicines during pregnancy. But some medicines can cause birth defects. It’s very important to talk to your doctor if you are planning to get pregnant. You may need to switch to another medicine.

If you don’t want to get pregnant, talk to your doctor about the best type of contraception to use. Some epilepsy medicines can stop the contraceptive pill and contraceptive injections working properly.

Things you can do for yourself

You may find it helpful to learn about epilepsy, so you know what to expect and how to live with it. Ask your doctor if there is an education programme you can attend.

People who go on an education programme sometimes have fewer seizures afterwards. That might be because the education programme helps them take their treatment the right way or to avoid things that can trigger a seizure. Children who go on these programmes often say they feel more positive and confident about life and that this helps them to do better at school.

For more background information on epilepsy see our leaflet Epilepsy: what is it?

What will happen to me?

Most people with epilepsy lead a full, healthy, and active life. There is very little that epilepsy stops them doing.

If you've had only one seizure, you may not have another. Nearly two-thirds of people don't have another seizure in the two years after their first. But if you've had two or more seizures you are very likely to have more. It's unlikely that the seizures will go away without treatment.

You or your child may be able to stop taking medicines if the seizures stop. But if the seizures don't stop you may need to take medicines for the rest of your life. If you have been free of seizures for two years you could talk to your doctor about stopping your medicines. But your chance of having another seizure goes up again when you stop taking your medicines.

You should not stop taking epilepsy medicines without a doctor’s help. Most people need to reduce the dose very gradually. Stopping taking these medicines suddenly can cause seizures.

Most seizures are not harmful. But they can increase your chances of having an injury. Very rarely, people with epilepsy can have a bad seizure that lasts a long time. Doctors call this status epilepticus. It can be dangerous.

Pregnancy

Having a baby when you have epilepsy is not as safe as for most women. But more than 90 in 100 women with epilepsy who get pregnant have a normal, healthy baby. If you're planning to get pregnant you should discuss your epilepsy treatment with your doctor first.

Epilepsy and driving, work, and leisure time

If you've had a seizure you must stop driving, even if you haven't been diagnosed with epilepsy. You will need to write to the relevant vehicle registration agency (for example, in the UK it's the DVLA) to let them know you've had a seizure. They might decide that you need to stop driving altogether. Or you may be allowed to start driving again if you don't have a seizure for a certain period of time.

You might also have to think about changes to the way you work: for example, if you work with machinery, or at height (for example, up ladders), or in a commercial kitchen. You might have to take similar precautions with your hobbies and leisure activities.

Surgery

Most people with epilepsy don't need surgery. But if medicines don’t work to control your epilepsy, you may be suitable for surgical treatments. This is a big step and you will need tests to be certain surgery is likely to help you. Your doctor will explain the types of surgery that might help.