The primary goal of epilepsy therapy is to prevent seizures as much as possible and minimize side effects.
When seizures are related to an identifiable illness or condition – such as overuse of alcohol or a severe chemical imbalance in the blood – the seizures usually go away when the problem is corrected. When no medical cause for seizures can be found and seizures continue to occur, antiepileptic medications are prescribed. Treatment of epilepsy can be complex. If a single medication doesn't fully control seizures, the next step is usually referral to a neurologist.
Status epilepticus is a life-threatening medical emergency. If not adequately treated, this condition can cause both brain damage and failure of other vital organs. Treatment includes administering antiepileptic medications intravenously (into a vein) until the seizures are controlled.
Antiepileptic medications can cause a variety of side effects, and side effects are more likely to occur with higher doses. Side effects include gastrointestinal upset, elevation of liver enzymes, low white blood cell counts with higher risk of infection, weight gain, drowsiness, confusion and memory problems, dizziness and balance problems, tremor, and double vision.
When medication fails to control a person's seizures, surgery may be considered. The decision to do surgery depends on many factors, including the frequency and severity of seizures, the patient's risk of brain damage or injury from frequent seizures, the effect on quality of life, the patient's overall health, and the likelihood that surgery will control the seizures.
Whether people who have a single, isolated seizure should be treated is controversial. Generally, treatment is recommended for patients who have abnormalities that show up in a neurological examination, brain scan or EEG. These abnormalities increase the chance that the person will have more seizures. Even for people who do not have these abnormalities, there is some evidence that treatment can reduce the risk of more seizures. This possible benefit needs to be balanced against the risk of side effects from medication.