Medical Management

A number of medications are available for patients who have epilepsy, and virtually all patients start treatment with one of the many anti-seizure medications available. For most patients, these medications offer good control with minimal side effects or adverse impacts to quality of life.

The oldest commonly used medication, phenobarbital, has been available for more than 100 years, and newer options have appeared almost every year since the mid-1990s.

The expanding range of medications allows you and your neurologist to decide together what medication is most appropriate for you depending on age, sex, childbearing potential, co-existing physical and psychological illnesses, concomitant medications for these conditions, academic demands, cost and convenience of dosing, and other considerations unique to you.

Some of the newer medications may be easier to tolerate than older drugs, and they frequently come in the form of extended release preparations that can be taken only once per day. In some cases, they may also be used to treat other common neurological conditions such as migraine, peripheral nerve pain or tremor.

With careful selection of medications, it is possible for up to two-thirds of patients to achieve complete seizure control with medication alone. Experience and research have shown, however, that if someone fails to achieve seizure control with trials of two appropriately chosen and well tolerated medications, the chances of getting seizure control with medication alone is only 4 to 5 percent. After failing to achieve seizure control with three medications, the chances of success with another drug drops to 1 percent.

There is generally no “magic cocktail” of medications that will control seizures after multiple trials of medications. When medication fails, however, a variety of surgical approaches may be considered. These range from surgical removal of the brain tissue where seizures originate to implantation of neuromodulation devices, which act as a sort of pacemaker for the brain.

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