Epilepsy
Treatment

Your neurology team at the Epilepsy Center, along with your primary care doctor, will design a treatment plan tailored to your condition and individual needs. You may require more than one kind of treatment — such as medication and surgery — and may be referred to or other medical professionals.

Medication

Most seizures can be prevented with medication. The type of medication prescribed for you will depend on your condition. Your neurologist will explain how to take your medication and what side effects might occur. Over time, your medication may be changed to find the right drug and dose. Be sure to take your medication as directed. Call your neurologist if you have questions or have any unexpected side effects.

Surgery

For some patients, surgery may be recommended to prevent seizures or to implant devices that deliver medications or stimulators to emit electrical impulses. Your neurologist will explain the procedure as well as possible risks.

These procedures include:

• Disconnection Procedures, which disrupt abnormal electrical activity that occurs in the brain and triggers epileptic seizures. Two types of disconnection operations are:
• Corpus callostomy, which stop atonic and tonic seizures.
• Multiple subpial transections, which are performed when seizures are caused by parts of the brain that can't be removed.
• Focal Resections — These procedures are the most common operations for treating epilepsy and provide the best chance for patients to gain complete seizure control. They involve the removal of a small area of the brain where seizures originate. New brain monitoring techniques allow doctors to better pinpoint brain tissue causing seizures. Types of resections include:
• Temporal lobectomy, where a portion of the temporal lobe is removed to control seizures.
• Lobar resection, where a portion of a seizure-producing lobe — frontal, parietal or occipital lobe — is removed, if it can be done without damaging vital functions.
• Hemispherectomy, where one sphere of the brain is removed or disabled. The remaining half of the brain takes over many of the functions of the half that was removed. This procedure is used to treat severe conditions that have not responded to other treatments.
• Gamma Knife Radiosurgery — This procedure delivers a finely focused, high dose of radiation to remove tissue without damaging surrounding tissue. Some types of seizures, such as gelastic seizures which are accompanied by brief, sudden bursts of emotion, can be treated with this technology. Doctors at UCSF Medical Center are involved in research using the Gamma Knife to treat temporal lobe epilepsy.
• Vagus nerve stimulation — This procedure involves minor surgery and is a relatively new treatment that helps prevent or lessen the severity of seizures. An electrical stimulator is implanted that sends regular electrical pulses through the vagus nerve to the brain to reduce the onset or frequency of seizes.

If a seizure occurs between doses of current, a magnet can be passed over the device to trigger an additional dose. If you have a vagus nerve stimulator implanted, you'll continue to take medication but sometimes can reduce the amount or number of medications. This procedure can treat a wide variety of seizure disorders when other surgical procedures aren't an option.

Most medical treatments can involve some risks or complications. Your neurologist will explain any possible risks or complications from the treatments you'll receive. Don't be afraid to ask your doctors, nurses or therapists about your treatment. If your treatment includes medication, be sure to take it exactly as the doctor has ordered. And remember to keep all your follow-up appointments with our doctors and other medical staff.

Prevention and follow-up

To help cope with epilepsy and reduce your chance of injury from seizures, we recommend these guidelines:

• Carry identification, including a bracelet, card or necklace that shows you have epilepsy. In an emergency, this information can ensure that you receive the right care.

• Explain to your family, friends and co-workers how to care for you if you have a seizure.

• Follow your state regulations about driving motor vehicles.

• If you are having regular or even occasional seizures, avoid dangerous situations at work and during leisure activities. For example, do not work in high places, on ladders or scaffolding, or near sharp or moving objects. Be careful when you play sports. Don't swim or go mountain climbing by yourself.

• Don't stop taking your seizure medication or change the amount you take unless you discuss this with your doctor.

• Talk with your doctor or pharmacist before you take other medications in addition to your seizure drugs.

If you are pregnant or are thinking of becoming pregnant and you have been diagnosed with epilepsy, talk to your neurologist as soon as possible. You may need to take vitamin supplements to protect your baby.

Reviewed by health care specialists at UCSF Medical Center.