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Treatment

Most people with epilepsy will take anti-seizure medication to prevent further seizures, but up to a third of people have drug resistant epilepsy, which means that other treatments may be more suitable.

Anti-seizure medication (ASM)

This is normally the first choice of treatment. ASMs come in a range of doses and forms. It works by controlling the electrical activity in the brain that causes seizures.

The majority of people with epilepsy will achieve seizure control with one ASM(called monotherapy) but some will require treatment with two or more drugs (known as polytherapy).

ASMs are tailored to suit each person with the aim to control seizures with minimum side effects on the lowest possible dose of a single drug.

There are specific ASMs that are used to treat serial seizures and status epilepticus, which is a condition in which seizures persist for 30 minutes or more.

It can occur with all types of seizures, but with tonic-clonic seizures it represents a medical emergency requiring immediate treatment if it lasts for more than five minutes.

This Research Roundtable webinar explains how Epilepsy Research Institute UK-funded scientists are exploring how to improve seizure control, including using technology to forecast them and through pioneering research into optogenetics.

Surgery

For people whose seizures are not well controlled with medication, surgery may be an option.

Brain scans and imaging techniques are able to precisely identify the region in the brain from where the epileptic activity occurs.

If the scans show the area is accessible, a full assessment is completed before a decision is made to undergo surgery. The assessment involves many tests and can take up to a year to complete.

If suitable, surgeons will remove the structural abnormality to stop seizures. Surgery is successful in six out of every ten patients.

A vagus nerve stimulator

This is a small device that is surgically implanted near the left collarbone in an operation which takes approximately an hour.

It is attached to the vagus nerve and is individually programmed to send electrical messages to the brain to reduce the frequency and duration of seizures.

A vagus nerve stimulator may be considered in cases where AEDs have failed and surgery is not an option.

Most people will still need to take medication.

The ketogenic diet

This high fat, low carbohydrate diet is sometimes recommended for children and adults with uncontrolled, refractory epilepsy. This is because chemicals called ketones are made when the body uses fat for energy (called ketosis).

With a keto diet, the body mostly uses ketones instead of glucose for its energy source. Randomised controlled trials have shown that following a keto diet has reduced seizures for some people.

Cannabis

While there is evidence that medical-grade preparations of an active ingredient of cannabis, cannabidiol, can be beneficial in some types of epilepsy, cannabis oil itself cannot be considered a safe or effective treatment.

This is due to the variety of compounds found in over-the-counter cannabis oils, some of which may have harmful effects. People with epilepsy and their families should consult their epilepsy specialist doctor for advice.