Your physician will determine specific treatment for a seizure, based on:

• Your age, overall health and medical history 
• Type of seizure 
• Frequency of seizures 
• Your tolerance for specific medications, procedures or therapies 
• Expectations for the course of the condition 
• Your opinion or preference

The goal of seizure management is to control, stop or decrease the frequency of the seizures without interfering with the normal activities of daily living (ADLs). The major goals of seizure management include the following:

• Proper identification of the type of seizure 
• Using medication specific to the type of seizure 
• Using the least amount of medication to achieve adequate control 
• Maintaining appropriate medication levels

Treatment may include:

• Medications
  There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the patient, side effects, the cost of the medication and the adherence with the use of the medication.
  
  Medications used at home are usually taken by mouth, but some can be given rectally (into the person's rectum). If the person is in the hospital with seizures, medication by injection or intravenous (IV) may be used.
  
  It is important to take your medication on time and as prescribed by your physician. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for the most effective seizure control.
  
  All medications can have side effects, although some people may not experience side effects. Discuss your medication’s side effects with your physician.
  
  While you are taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:
  • Blood work
    Frequent blood draws testing is usually required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication to achieve the desired, “therapeutic” level, where the medication works most efficiently. Blood work may also be done to monitor the effects of medications on body organs.
  • Urine tests
    These tests are performed to see how the person’s body is responding to the medication.
  • Electroencephalogram (EEG)
    An EEG is a procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems in the brain.
    
• Vagus nerve stimulation
  Some people whose seizures are not being well controlled with seizure medications may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently only used for persons over the age of 12 who have partial seizures that are not controlled by other methods.
  
  VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the person feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure.
  
  There are some side effects that may occur with the use of VNS. These may include, but are not limited to:
  • Hoarseness
  • Pain or discomfort in the throat 
  • Change in voice

For more information about the benefits of VNS, view Jefferson’s Epileptic Seizures Online Video.

• Surgery
  Surgery may be considered for a person who has:
  • Seizures that are unable to be controlled with medications 
  • Seizures that always start in one area of the brain 
  • A seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory or vision

Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain.

A person may be awake during the surgery. The brain itself does not feel pain. With the person awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.

Surgery is not an option for everyone with seizures. Discuss this treatment option with your physician for more information.

Epilepsy surgery at Jefferson Hospital for Neuroscience