Treatment for epilepsy will not normally begin unless you have a second seizure. This is because a single seizure is not a totally reliable indicator that you have epilepsy. However, treatment will begin after a first seizure if:

• your EEG test shows brain activity that is associated with epilepsy,
• the MRI scan shows that there is a defect in the structure of your brain, or
• if you have a known condition that has caused damage to your brain, such as a stroke.

You can also request that treatment begins after a first seizure.

Anti-epileptic drugs (AEDs)

The majority of people with epilepsy can be successfully treated with medicines known as anti-epileptic drugs (AEDs). AEDs do not cure epilepsy, but they do prevent seizures from occurring.

There are many different AEDs, but they all tend to work by either:

• altering the electric transmissions in your brain in a way that reduces the chance of a seizure, or
• altering the chemicals in your brain in a way that reduces the chance of a seizure.

Side effects are common when starting treatment with AEDs but they normally pass in a few days. Common side effects include:

• nausea,
• abdominal pain,
• drowsiness,
• dizziness,
• irritability, and
• mood changes.

Some side effects, which produce symptoms that are similar to being drunk, occur when the dose of AEDs you are taking is too high. They include:

• unsteadiness,
• poor concentration,
• drowsiness,
• vomiting, and
• double vision.

If you experience any of these symptoms contact your doctor, or epilepsy specialist, immediately, so that your dosage can be revised.

It is important that you follow any advice regarding when to take AEDs, and how much you should take. You should never suddenly stop taking an AED because doing so could cause a seizure.

While taking AEDs, you should not take any other medicines, including over-the-counter (OTC) medicines, or complementary medicines, such as St Johns Wort, without first consulting with your doctor, or epilepsy specialist.

This is because other medicines could cause a dangerous interaction with your AED and cause a seizure to occur.

If you do not respond to initial treatment, your epilepsy specialist will try a different sort of AED. However, it can be dangerous to immediately switch from one AED to another. Instead, your old AED dose will be gradually reduced, while your new AED dose is gradually increased.

If you still do not respond to treatment, a combination of different AED may be required.

If you remain seizure free for more than two years, it may be possible for you to stop taking your AED. Your epilepsy specialist will be able to discuss with you the best way to safely withdraw from your AED.

For more information about the different types of AED available, see the 'medicine guide' section of this article.

Vagus nerve stimulation (VNS)

If, after trying various types of AED, your epilepsy is still poorly controlled, vagus nerve stimulation (VNS) therapy may be recommend for you. This involves surgically implanting a small electrical device, similar to pacemaker, under your skin, near your collar bone.

The device has a lead which is wrapped around one of the nerves in the left side of your neck, known as the vagus nerve. The device passes a regular dose of electricity to the nerve, 'stimulating' it. This can help to reduce the frequency and severity of seizures.

Also, if you feel the warning sign of a seizure coming on, you can activate an extra 'burst' of stimulation that can often prevent the seizure from occurring.

How and why VNS works is still not fully understood, but it is thought that stimulating the vagus nerve alters the chemical transmissions in the brain.

Most people who undergo VNS still need to take AED.

Some mild to moderate side effects of VNS have been reported including:

• temporary hoarseness and change in voice tone when the device is being used (this is normally occurs every five minutes and lasts for 30 seconds),
• sore throat,
• shortness of breath, and
• coughing.

Ketogenic diet

Before AEDs were first introduced in the 1950s and 60s, one of the treatments for epilepsy was the ketogenic diet. This is a diet that is high in fats, and low in carbohydrates and protein. This diet can alter the chemical composition of your brain, making seizures less likely.

The diet may be of benefit to children who are not responding well to other forms of treatment. However, it is not recommended for adults as the composition of the diet can cause other serious health conditions, such as high blood pressure (hypertension), strokes, and heart disease.

Surgery

If your epilepsy is still poorly controlled after two years of treatment, you may be referred to a specialist epilepsy center to see if you are suitable for surgery.

Surgery is only recommended when:

• a single area of only one side of the brain is causing seizures, and
• removing that part of the brain would not cause any significant loss of brain function.

As with all types of surgery, this procedure carries a risk. Around 1 in every 100 people experience a stroke after surgery. Also 5% of people will experience a deterioration of their memory after surgery.


Before having the procedure, your surgeon will explain to you the benefits and risks of the surgery.

Most people normally recover from the effects of surgery after a few days, but it could be 2-3 months before you are fully fit and able to return to work.