Treatment Overview
Living with seizures, or a diagnosis of epilepsy, often brings a sense of unpredictability to daily life. The fear of when the next seizure might occur can affect everything from driving and employment to simple activities like swimming or cooking. It is a condition that impacts not just physical safety but also independence and emotional well-being. However, with the right management plan, many individuals achieve stability and lead full, active lives without constant disruption.
Treatment is critical to prevent the physical injury that can result from a fall or convulsion and to protect the brain from the stress of prolonged electrical activity. The primary goal is “seizure freedom” eliminating seizures entirely without causing unmanageable side effects. Because seizures arise from different areas of the brain and have various causes, treatment is not one-size-fits-all. A medication that works for one type of epilepsy may be ineffective or even harmful for another, making accurate diagnosis the first step in care (Epilepsy Foundation, 2023).
Overview of treatment options for Seizures
The cornerstone of seizure management is Anti-Seizure Medication (ASM), historically referred to as anticonvulsants. For the vast majority of patients, daily oral medication is the first and most effective line of defense. The strategy typically begins with “monotherapy” using a single drug at the lowest effective dose to control symptoms.
If a single medication does not provide control, doctors may add a second drug or switch therapies. While surgery, dietary therapies (like the ketogenic diet), and neurostimulation devices (such as VNS) are options, they are generally reserved for drug-resistant epilepsy. Medications remain the foundation for both acute management and long-term prevention.
Medications used for Seizures
There are over 30 different anti-seizure medications available today, categorized by how they affect the brain and which seizure types they treat.
Broad-spectrum medications are commonly used because they are effective against multiple types of seizures (both generalized and focal). Levetiracetam is a widely prescribed first-line option due to its effectiveness and lack of interaction with other drugs. Lamotrigine is another common choice, often favored for women of childbearing age due to a safer profile during pregnancy. Valproic acid is highly effective for generalized epilepsy but is used cautiously due to side effects.
Narrow-spectrum medications target specific seizure types. Carbamazepine and oxcarbazepine are frequently used for focal seizures (seizures starting in one part of the brain). For absence seizures, which look like staring spells, ethosuximide is the standard treatment.
In addition to daily maintenance drugs, doctors may prescribe “rescue medications.” These are fast-acting benzodiazepines, such as diazepam or midazolam, administered via nasal spray or rectal gel. They are used to stop a seizure cluster or a prolonged seizure immediately. Clinical experience suggests that about two-thirds of people with epilepsy can become seizure-free with medication alone (National Institute of Neurological Disorders and Stroke, 2024).
How these medications work
A seizure is an electrical storm in the brain caused by an imbalance between excitatory and inhibitory nerve signals. Anti-seizure medications restore this balance.
Some drugs, such as phenytoin and lamotrigine, block sodium or calcium channels on neurons, preventing rapid or repetitive firing.
Other medications, like benzodiazepines and phenobarbital, increase the activity of GABA, the brain’s main inhibitory neurotransmitter. This acts as a brake, calming electrical activity and raising the “seizure threshold” to prevent seizures from spreading (Mayo Clinic, 2022).
Side effects and safety considerations
Anti-seizure medications (ASMs) commonly cause side effects like drowsiness, dizziness, fatigue, and difficulty concentrating (“brain fog”); these often lessen over time.
Some ASMs pose serious risks. Lamotrigine requires slow introduction to prevent severe rash (Stevens-Johnson syndrome). Valproic acid risks liver strain and birth defects, often leading to its avoidance in women planning pregnancy. Monitoring mental health is also necessary due to potential mood changes or irritability.
Strict adherence is crucial, as missing a single dose can trigger a seizure. Seek immediate medical attention if a seizure lasts over five minutes (status epilepticus), breathing is difficult, or a new rash appears after starting medication (Centers for Disease Control and Prevention, 2022).
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- Centers for Disease Control and Prevention. https://www.cdc.gov
- Epilepsy Foundation. https://www.epilepsy.com
- Mayo Clinic. https://www.mayoclinic.org
- National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov
Medications for Seizures
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Seizures.