Can Epilepsy be Prevented?
Many cases of epilepsy can be prevented by wearing seatbelts and bicycle helmets, putting children in car seats, and other measures that prevent head injury and other trauma. Prescribing medication after first or second seizures or febrile seizures also may help prevent epilepsy in some cases. Good prenatal care, including treatment of high blood pressure and infections during pregnancy, can prevent brain damage in the developing baby that may lead to epilepsy and other neurological problems later. Treating cardiovascular disease, high blood pressure, infections, and other disorders that can affect the brain during adulthood and aging also may prevent many cases of epilepsy. Finally, identifying the genes for many neurological disorders can provide opportunities for Genetic screening and prenatal diagnosis that may ultimately prevent many cases of epilepsy.

How can Epilepsy be Treated?
Accurate diagnosis of the type of epilepsy a person has is crucial for finding an effective treatment. There are many different ways to treat epilepsy. Currently available treatments can control seizures at least some of the time in about 80 percent of people with epilepsy. However, another 20 percent -- about 600,000 people with epilepsy in the United States -- have intractable seizures, and another 400,000 feel they get inadequate relief from available treatments. These statistics make it clear that improved treatments are desperately needed.

Doctors who treat epilepsy come from many different fields of medicine. They include neurologists, pediatricians, Pediatric neurologists, internists, and family physicians, as well as neurosurgeons and doctors called epileptologists who specialize in treating epilepsy. People who need specialized or intensive care for epilepsy may be treated at large medical centers and neurology clinics at hospitals or by neurologists in private practice. Many epilepsy treatment centers are associated with university hospitals that perform research in addition to providing medical care.

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. Research suggests that medication and other treatments may be less successful in treating epilepsy once seizures and their consequences become established.

Medications
By far the most common approach to treating epilepsy is to prescribe antiepileptic drugs.  The first effective antiepileptic drugs were bromides, introduced by an English physician named Sir Charles Locock in 1857.  He noticed that bromides had a sedative effect and seemed to reduce seizures in some patients.  More than 20 different antiepileptic drugs are now on the market, all with different benefits and side effects.  The choice of which drug to prescribe, and at what dosage, depends on many different factors, including the type of seizures a person has, the person’s lifestyle and age, how frequently the seizures occur, and, for a woman, the likelihood that she will become pregnant.  People with epilepsy should follow their doctor’s advice and share any concerns they may have regarding their medication.

Doctors seeing a patient with newly developed epilepsy often prescribe carbamazapine, valproate, lamotrigine, oxcarbazepine, or phenytoin first, unless the epilepsy is a type that is known to require a different kind of treatment.  For absence seizures, ethosuximide is often the primary treatment.  Other commonly prescribed drugs include clonazepam, phenobarbital, and primidone.   Some relatively new epilepsy drugs include tiagabine, gabapentin, topiramate, levetiracetam, and felbamate.   Other drugs are used in combination with one of the standard drugs or for intractable seizures that do not respond to other medications.  A few drugs, such as fosphenytoin, are approved for use only in hospital settings to treat specific problems such as status epilepticus (see section, “Are There Special Risks Associated With Epilepsy?” ).  For people with stereotyped recurrent severe seizures that can be easily recognized by the person’s family, the drug diazepam is now available as a gel that can be administered rectally by a family member.  This method of drug delivery may be able to stop prolonged or repeated seizures before they develop into status epilepticus. 

For most people with epilepsy, seizures can be controlled with just one drug at the optimal dosage.  Combining medications usually amplifies side effects such as Fatigue and decreased appetite, so doctors usually prescribe monotherapy, or the use of just one drug, whenever possible.  Combinations of drugs are sometimes prescribed if monotherapy fails to effectively control a patient’s seizures.

The number of times a person needs to take medication each day is usually determined by the drug’s half-life, or the time it takes for half the drug dose to be metabolized or broken down into other substances in the body.  Some drugs, such as phenytoin and phenobarbital, only need to be taken once a day, while others such as valproate must be taken two or three times a day.

Most side effects of antiepileptic drugs are relatively minor, such as fatigue, dizziness, or weight gain.  However, severe and life-threatening side effects such as allergic reactions can occur.  Epilepsy medication also may predispose people to developing Depression or psychoses.  People with epilepsy should consult a doctor immediately if they develop any kind of rash while on medication, or if they find themselves depressed or otherwise unable to think in a rational manner.  Other danger signs that should be discussed with a doctor immediately are extreme fatigue, staggering or other movement problems, and slurring of words.  People with epilepsy should be aware that their epilepsy medication can interact with many other drugs in potentially harmful ways.  For this reason, people with epilepsy should always tell doctors who treat them which medications they are taking.  Women also should know that some antiepileptic drugs can interfere with the effectiveness of oral contraceptives, and they should discuss this possibility with their doctors.

Since people can become more sensitive to medications as they age, they may need to have their blood levels of medication checked occasionally to see if the dose needs to be adjusted.  The effects of a particular medication also sometimes wear off over time, leading to an increase in seizures if the dose is not adjusted.  People should know that some citrus fruit, in particular grapefruit juice, may interfere with breakdown of many drugs.  This can cause too much of the drug to build up in their bodies, often worsening the side effects.

People taking epilepsy medication should be sure to check with their doctor and/or seek a second medical opinion if their medication does not appear to be working or if it causes unexpected side effects.