An accurate diagnosis of the type of epilepsy (not just the type of seizure, since most seizure types occur in different types of epilepsy) is also critical to choosing the best treatment.

Treatment options

• Antiepileptic medications/ anticonvulsants
• Epileptic surgeries
• Vagus nerve stimulation
• Ketogenic diet

Antiepileptic medications

Older classic medications

• Phenobarbitone
• Phenytoin
• Carbamazepine
• Divalproex sodium
• Primidone
• Trimethadione
• Potassium bromide

Established class of drugs

• Sodium Valproate
• Ethosuximide
• Clonazepam
• Lorazepam

Newer antiepileptic drugs

• Gabapentin
• Pregabalin
• Lamotrigine
• Oxcarbazepine
• Vigabatrin
• Tiagabine
• Levitiracetam
• Felbamate
• Zonisamide
• Topiramate

Drug of choice in treatment in treatment of specific seizure type

Newer antiepileptic drugs offer no more effective treatment than the established drugs, but the newer drugs have fewer side effects and better are tolerated.

Once seizure attacks are well controlled, the drug should be continued without interruption until patients have been seizure-free or symptom free period of at least 2 yr. At that time, stopping the drug may be considered.

Causes of relapse in seizure attacks

Of patients who relapse, about 60% do so within 1 yr, and 80% within 2 yr. Patients who have a relapse when they are not taking anticonvulsants should be treated indefinitely

• A seizure disorder since childhood
• Need for > 1 drug to be seizure-free
• Previous seizures while taking an anticonvulsant
• Partial or myoclonic seizures       
• Underlying static encephalopathy
• Abnormal EEG results within the last year

Adverse effects of antiepileptic drugs

• Common neurological side effects- blurry or double vision, fatigue, sleepiness, unsteadiness, short term memory loss, dizziness, and disorientation
• Other side effects-  nausea, vomiting, skin rashes, reduced blood counts, fatty liver, and hair loss

Epileptic surgery

70- 75% of epileptic patients can be managed by proper antiepileptic medications

The remaining 20- 25% patients come under medically intractable epilepsy, which need surgical intervention.

Brain surgery in epilepsy

Resection or resective surgery

• In this type, the surgeon removes the area of the brain that causes the patient's seizures.
• The most common example of this type of surgery is the temporal lobectomy, in which part of the temporal lobe of the brain is removed.
• Resective surgeries include lesionectomy, amygdalo hippocampectomy with or without temporal lobe resection, and multilobar resection.

Disconnective epileptic surgeries

• It’s less common type of epilepsy surgery that interrupts nerve pathways that allow seizures to spread.
• Non resective surgeries include multiple subplial transection, corpus callosotomy and vagus nerve stimulation
• Disconnection procedures are generally thought of as providing relief, but not a cure.

Vagus nerve stimulation

• Its new treatment which involves electrical stimulation of  left vagus nerve
• This treatment requires minor surgery to implant a stimulator, which is about the size of a silver dollar.
• The stimulator is placed under the skin in the upper chest, like a pacemaker.
• Vagus nerve stimulation decreases seizure frequency by half more than in 40%-50% of patients, but rarely eliminates all seizures.
• Almost all patients need to continue taking medications after the stimulator has been placed, although many people can take fewer medicines.

Ketogenic diet

• Ketogenic diet has traditionally used primarily in treating childhood epilepsy mainly Lennox gastaut syndrome.
• It’s a low carbohydrate, high fat and adequate protein used to treat refractory epilepsy in childhood.
• The diet is usually started in the hospital, and when successful, it is most often maintained for 2 to 3 years.