Epilepsy treatment: how to control seizures and stay safe

If you or someone you care for has epilepsy, the goal is clear: reduce seizures with the fewest side effects and keep life normal. Treatment isn’t one-size-fits-all. Doctors build a plan based on seizure type, test results, side effects, and your daily life. Here’s a practical overview so you know the options and what to expect.

Medications: the first and most common step

Most people start with antiepileptic drugs (AEDs). Common choices include levetiracetam (Keppra), lamotrigine (Lamictal), carbamazepine (Tegretol), valproate (Depakote), and topiramate (Topamax). Ethosuximide works well for absence seizures. Some meds need blood tests to check levels (phenytoin, valproate) and others require slow dose changes to avoid rash (lamotrigine).

Side effects vary: tiredness, dizziness, mood changes, or weight changes. Valproate controls many seizure types but raises the risk of birth defects, so women planning pregnancy usually consider other options. Always tell your doctor about other drugs and supplements—interactions matter.

When meds aren’t enough: surgery, diets, and devices

If seizures continue after two well-chosen drugs, talk to an epilepsy specialist about other steps. Surgery can cure or greatly reduce seizures for people with a clear focus on brain scans and EEG. Temporal lobectomy is common for temporal lobe epilepsy. Other surgeries, like corpus callosotomy, reduce drop attacks.

Dietary therapy helps some people—especially kids. The ketogenic diet (high fat, low carb) and modified Atkins diet can cut seizures when meds fail. These need supervision by a dietitian and medical team.

Neurostimulation devices offer another route. Vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) reduce seizure frequency for many patients. Deep brain stimulation (DBS) is another option in select cases.

For certain rare syndromes, cannabidiol (Epidiolex) is FDA-approved and can help severe childhood epilepsies like Dravet and Lennox-Gastaut.

Practical tips: take meds the same time every day, keep a seizure diary, and review side effects regularly. Driving rules and job safety vary—ask your neurologist.

Seizure first aid: stay calm, cushion the head, clear hard objects, don’t hold the person down, and roll them onto their side if breathing is abnormal. Call emergency services if the seizure lasts longer than 5 minutes, repeats without recovery, or if the person is injured, pregnant, or has diabetes.

When to see a specialist: uncontrolled seizures, new seizure types, planning pregnancy, or strong medication side effects. An epilepsy center can offer testing, surgery evaluation, diet programs, and device options.

Epilepsy treatment is a team effort. Keep open communication with your neurologist, report changes, and ask about all options. The right plan makes a huge difference—many people with epilepsy lead full, active lives.