Materiały źródłowe

• #1 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/treatment/

  Epilepsy is a condition that affects your brain and causes seizures (sometimes called fits). It cannot currently be cured, but treatment can often help manage it. […] If you have epilepsy you’ll be supported by your GP and a team of specialists. You’ll have check-ups at least once a year. […] Your team will work with you to agree a care plan that includes details of the care and support you need. The care plan will tell your family or carers what to do when you have a seizure. […] The main treatment for epilepsy is medicine to prevent seizures, called anti-epileptic or anti-seizure medicine. […] You may also be given medicine to use as emergency treatment if you have a seizure that lasts longer than usual. A family member or carer will need to give this to you. […] There are different anti-epileptic medicines. The medicine recommended for you depends on the type of seizures and things like your age, sex and any other conditions you have.

• #1 Epilepsy medicines – Epilepsy Action

  https://www.epilepsy.org.uk/info/treatment/anti-seizure-medication

  The main treatment for epilepsy is taking epilepsy medicines. They are also known as epilepsy medication, anti-seizure medications (ASMs) or anti-epileptic drugs (AEDs). […] They dont cure epilepsy, but try to prevent seizures from happening. They do this by changing the levels of chemicals in the brain that control electrical activity. […] Deciding whether to take epilepsy medicines or not should be a joint decision between you and your specialist. If you need help deciding, the specialist should also involve your family or carer. […] There are many different epilepsy medicines available. When the specialist is deciding which one will best suit you, they will consider things like: The types of seizure you have, as some medicines are only effective for certain types of seizure. […] Research has shown that some epilepsy medicines could be harmful to an unborn baby if taken during pregnancy.

• #2 Principles of Therapy in Epilepsies – The Epilepsies – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2607/

  The aim of therapy in epilepsies is total seizure freedom without clinically significant adverse effects. This is achievable in more than two-thirds of patients with epileptic seizures. […] Antiepileptic drug treatment is the mainstay of management of epilepsies. The decision to treat is based on a careful evaluation of the balance between the likelihood of further seizures and the risk of adverse effects of treatment. […] The laudable goal of AED treatment in epilepsies is to abolish seizures completely (freedom of seizures) with minimal if any drug-related adverse reactions. This is achieved in around 50-70% of patients with a single appropriately selected AED at target therapeutic doses. […] Freedom of seizures should not be pursued at any cost and, in particular, at the expense of drug-induced adverse reactions.

• #2 Treatment of Epilepsy | Epilepsy | CDC

  https://www.cdc.gov/epilepsy/treatment/index.html

  Anti-seizure medicines are used to stop seizures. […] Other treatments may help some people with epilepsy. […] See a neurologist or epileptologist (a neurologist who specializes in epilepsy) if your seizures don’t stop. […] The most common treatments for epilepsy are medicine, surgical procedures, seizure devices, and a special diet. […] Anti-seizure medicines limit the spread of seizures in the brain. […] Medicines work for about 2 in 3 people with epilepsy. […] If your seizures continue while taking medicine, tell your health care provider right way. […] They may want to change the amount or type of medicine you take. […] You should not skip or stop taking your seizure medicine without talking to your provider. […] Suddenly stopping your medicine might cause withdrawal symptoms, including life-threatening seizures.

• #3 Treatment | Epilepsy Ireland

  https://www.epilepsy.ie/content/treatment

  In most cases epilepsy is treated with medication. Over the past decades new medications for epilepsy have become available which allow many people with epilepsy to live virtually seizure-free lives. However, many medications are likely to be most effective in controlling only certain types of epilepsy. Treatment decisions start with knowing the kind of epilepsy the person has. Your doctor will choose a medication best suited to your type of epilepsy. […] Most people with epilepsy can look forward to becoming free of seizures. With Anti-Seizure Medication treatment, up to 70% of people living with epilepsy can become seizure free if the right treatment is identified. A small number benefit from epilepsy surgery which, in some cases, can manage the condition completely. […] However, for up to 30% of people with epilepsy, seizures are difficult to control despite treatment. Seizures by their nature can pose risks to a person’s safety. The best way to lower your safety risk is to get the best control possible of your seizures. Getting a diagnosis of epilepsy is the first step. Working with your medical team to find the right treatment for you is the next stage. Regular follow-up with your medical team is important too. […] This section of our website will delve further into all the above with information on a key range of topics related to the treatment of epilepsy, and approaches which may be taken to treating your epilepsy.

• #4 Epilepsy medicines – Epilepsy Action

  https://www.epilepsy.org.uk/info/treatment/anti-seizure-medication

  The main treatment for epilepsy is taking epilepsy medicines. They are also known as epilepsy medication, anti-seizure medications (ASMs) or anti-epileptic drugs (AEDs). […] They dont cure epilepsy, but try to prevent seizures from happening. They do this by changing the levels of chemicals in the brain that control electrical activity. […] Deciding whether to take epilepsy medicines or not should be a joint decision between you and your specialist. If you need help deciding, the specialist should also involve your family or carer. […] There are many different epilepsy medicines available. When the specialist is deciding which one will best suit you, they will consider things like: The types of seizure you have, as some medicines are only effective for certain types of seizure. […] Research has shown that some epilepsy medicines could be harmful to an unborn baby if taken during pregnancy.

• #5 Antiseizure medicines for management of epilepsy in adults and children

  https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/epilepsy-and-seizures/antiseizure-medicines-for-management-of-epilepsy-in-adults-and-children

  Monotherapy with lamotrigine or levetiracetam, or valproic acid (sodium valproate), should be offered as first-line treatment for generalized onset seizures in men/boys and women/girls who are not of childbearing potential. […] In women and girls of childbearing potential with generalized onset seizures, lamotrigine or levetiracetam should be offered as first-line monotherapy. […] If the first monotherapy is not successful for generalized onset seizures, an alternative first-line monotherapy should be tried. […] Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy. […] If the first monotherapy is not successful for focal onset seizures, an alternative first-line monotherapy should be tried.

• #6 Epilepsy and Seizures Treatment & Management: Approach Considerations, Anticonvulsant Therapy, Anticonvulsants for Specific Seizure Types

  https://emedicine.medscape.com/article/1184846-treatment

  The goal of treatment in patients with epileptic seizures is to achieve a seizure-free status without adverse effects. This goal is accomplished in more than 60% of patients who require treatment with anticonvulsants. Many patients experience adverse effects from these drugs, however, and some patients have seizures that are refractory to medical therapy. A 2017 study found that fewer than two thirds of patients with newly diagnosed epilepsy are seizure-free after 1 year. A smaller study published in 2000 found the seizure-free rate to be 64%, which is almost identical to the rate found in the newer study. […] […] Monotherapy is desirable because it decreases the likelihood of adverse effects and avoids drug interactions. In addition, monotherapy may be less expensive than polytherapy, as many of the older anticonvulsant agents have hepatic enzymeinducing properties that decrease the serum level of the concomitant drug, thereby increasing the required dose of the concomitant drug. […]

• #7 Epilepsy and Seizures Treatment & Management: Approach Considerations, Anticonvulsant Therapy, Anticonvulsants for Specific Seizure Types

  https://emedicine.medscape.com/article/1184846-treatment

  The goal of treatment in patients with epileptic seizures is to achieve a seizure-free status without adverse effects. This goal is accomplished in more than 60% of patients who require treatment with anticonvulsants. Many patients experience adverse effects from these drugs, however, and some patients have seizures that are refractory to medical therapy. A 2017 study found that fewer than two thirds of patients with newly diagnosed epilepsy are seizure-free after 1 year. A smaller study published in 2000 found the seizure-free rate to be 64%, which is almost identical to the rate found in the newer study. […] […] Monotherapy is desirable because it decreases the likelihood of adverse effects and avoids drug interactions. In addition, monotherapy may be less expensive than polytherapy, as many of the older anticonvulsant agents have hepatic enzymeinducing properties that decrease the serum level of the concomitant drug, thereby increasing the required dose of the concomitant drug. […]

• #8 Antiseizure medicines for management of epilepsy in adults and children

  https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/epilepsy-and-seizures/antiseizure-medicines-for-management-of-epilepsy-in-adults-and-children

  Monotherapy with lamotrigine or levetiracetam, or valproic acid (sodium valproate), should be offered as first-line treatment for generalized onset seizures in men/boys and women/girls who are not of childbearing potential. […] In women and girls of childbearing potential with generalized onset seizures, lamotrigine or levetiracetam should be offered as first-line monotherapy. […] If the first monotherapy is not successful for generalized onset seizures, an alternative first-line monotherapy should be tried. […] Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy. […] If the first monotherapy is not successful for focal onset seizures, an alternative first-line monotherapy should be tried.

• #9 Treatment of Epilepsy | Epilepsy | CDC

  https://www.cdc.gov/epilepsy/treatment/index.html

  Anti-seizure medicines are used to stop seizures. […] Other treatments may help some people with epilepsy. […] See a neurologist or epileptologist (a neurologist who specializes in epilepsy) if your seizures don’t stop. […] The most common treatments for epilepsy are medicine, surgical procedures, seizure devices, and a special diet. […] Anti-seizure medicines limit the spread of seizures in the brain. […] Medicines work for about 2 in 3 people with epilepsy. […] If your seizures continue while taking medicine, tell your health care provider right way. […] They may want to change the amount or type of medicine you take. […] You should not skip or stop taking your seizure medicine without talking to your provider. […] Suddenly stopping your medicine might cause withdrawal symptoms, including life-threatening seizures.

• #10 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/treatment/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you or your partner are taking epilepsy medicine and there’s a chance you could get pregnant it’s very important to discuss your treatment with a specialist. […] You might also need to change your medicine as some epilepsy medicines are not safe to take in pregnancy. […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #11 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. Do not change your dose or stop taking your medicine without talking to your specialist. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #12 Antiseizure medicines for management of epilepsy in adults and children

  https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/epilepsy-and-seizures/antiseizure-medicines-for-management-of-epilepsy-in-adults-and-children

  Monotherapy with lamotrigine or levetiracetam, or valproic acid (sodium valproate), should be offered as first-line treatment for generalized onset seizures in men/boys and women/girls who are not of childbearing potential. […] In women and girls of childbearing potential with generalized onset seizures, lamotrigine or levetiracetam should be offered as first-line monotherapy. […] If the first monotherapy is not successful for generalized onset seizures, an alternative first-line monotherapy should be tried. […] Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy. […] If the first monotherapy is not successful for focal onset seizures, an alternative first-line monotherapy should be tried.

• #13 Epilepsy and Seizures Treatment & Management: Approach Considerations, Anticonvulsant Therapy, Anticonvulsants for Specific Seizure Types

  https://emedicine.medscape.com/article/1184846-treatment

  The mainstay of seizure treatment is anticonvulsant medication. The drug of choice depends on an accurate diagnosis of the epileptic syndrome, as response to specific anticonvulsants varies among different syndromes. The difference in response probably reflects the different pathophysiologic mechanisms in the various types of seizure and the specific epileptic syndromes. […] […] Some anticonvulsants (eg, lamotrigine, topiramate, valproic acid, zonisamide) have multiple mechanisms of action, and some (eg, phenytoin, carbamazepine, ethosuximide) have only 1 known mechanism of action. Anticonvulsants can be divided into large groups based on their mechanisms. […] […] If only absence seizures are present, most neurologists treat them with ethosuximide. If absence seizures are present along with other seizure types (eg, generalized tonic-clonic seizures, myoclonic seizures), the choices are valproic acid, lamotrigine, or topiramate. […]

• #14 Antiseizure medicines for management of epilepsy in adults and children

  https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/epilepsy-and-seizures/antiseizure-medicines-for-management-of-epilepsy-in-adults-and-children

  Monotherapy with lamotrigine or levetiracetam, or valproic acid (sodium valproate), should be offered as first-line treatment for generalized onset seizures in men/boys and women/girls who are not of childbearing potential. […] In women and girls of childbearing potential with generalized onset seizures, lamotrigine or levetiracetam should be offered as first-line monotherapy. […] If the first monotherapy is not successful for generalized onset seizures, an alternative first-line monotherapy should be tried. […] Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy. […] If the first monotherapy is not successful for focal onset seizures, an alternative first-line monotherapy should be tried.

• #15 Epilepsy and Seizures Treatment & Management: Approach Considerations, Anticonvulsant Therapy, Anticonvulsants for Specific Seizure Types

  https://emedicine.medscape.com/article/1184846-treatment

  Tonic or atonic seizures are dramatic seizures. Patients with Lennox-Gastaut syndrome may have seizures, and this syndrome is best treated with broad-spectrum drugs (eg, valproic acid, lamotrigine, topiramate) or felbamate as a last resort. […] […] The best medications for JME and myoclonic seizures are valproic acid, lamotrigine, and topiramate. Levetiracetam is approved by the FDA for adjunctive therapy of JME; this is the first medication approved for this syndrome. […] […] Primary generalized tonic-clonic seizures respond to valproic acid, topiramate, or lamotrigine. Levetiracetam and perampanel are indicated as adjunctive therapy for these seizures. […] […] The SANAD trial investigators concluded that valproate should remain the drug of first choice for many patients with generalized and unclassified epilepsies, as it is better tolerated than topiramate and more efficacious than lamotrigine. […]

• #16 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/treatment/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you or your partner are taking epilepsy medicine and there’s a chance you could get pregnant it’s very important to discuss your treatment with a specialist. […] You might also need to change your medicine as some epilepsy medicines are not safe to take in pregnancy. […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #17 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine

  https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people

  Dr. Hirsch and other Yale Medicine epilepsy specialists answered questions about the latest approaches and advances in refractory epilepsy treatment and how they are giving more patients a better quality of life—and, in some cases, providing a cure. […] Medication is still the first line of treatment for epilepsy. […] While drugs won’t cure epilepsy, they allow an estimated 70% of people with the condition to manage it to the point where it barely interferes with their daily life. […] Epilepsy surgery might be considered if two or more anti-seizure medications (without significant side effects) are tried and don’t stop the seizures, giving the condition the classification of refractory epilepsy. […] The goal of surgery is to identify and target the area (or areas) in the brain causing the seizures and remove or otherwise disable it, without harming nearby areas that regulate important functions, such as speech or memory.

• #18 Treatment of Epilepsy | Epilepsy | CDC

  https://www.cdc.gov/epilepsy/treatment/index.html

  When seizures come from a single area of the brain (focal seizures), surgery might be helpful. […] If medicine doesn’t work and surgery isn’t an option, there are other treatments that might help. […] Your doctor may suggest: Ketogenic diet: This is a strict, high-fat, low-carbohydrate diet. […] It’s important to see a specialist if your seizures aren’t controlled with medicine. […] An epilepsy center can help if your seizures are hard to control or you need specialized care. […] The most important thing you can do is take your anti-seizure medicine as prescribed. […] Get answers to questions about epilepsy and its treatment.

• #19 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine

  https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people

  When the brain tissue causing the seizures is identified, there are two types of surgery to eliminate it: Resection (or cutting out the tissue causing the seizures) and Laser ablation to destroy the abnormal tissue. […] A third option, called neurostimulation (or neuromodulation), involves implanting devices in the body to control the seizures. […] Neurostimulation is considered when surgery or laser ablation is too difficult or risky, often because a clear focal point of seizure origin does not exist or can’t be identified. […] The rate of complete freedom from seizures is lower than with resection or laser ablation, and most patients also continue to take medication to treat the seizures. […] Patients should consider surgery as soon as it’s clear they can’t easily control their seizures with medication.

• #20 Epilepsy Treatments & Procedures | NewYork-Presbyterian

  https://www.nyp.org/neuro/epilepsy/treatment

  Respective surgery is the most common surgery for epilepsy. The surgeon removes a small section of the brain. The section removed is usually the site of the tumor, brain injury, or malformation. Most surgeries of this type are done on one of the temporal lobes—the area of the brain that controls vision, memory, speech, comprehension, and emotions. […] Laser interstitial thermal therapy (LITT) is considered less invasive. The surgeon uses an MRI to guide and locate the area of brain tissue causing the seizures. The surgeon uses a laser to remove this area if the area is small and limited in scope. […] Corpus callosotomy. This surgery is usually performed on children whose abnormal brain activity spreads from one side of the brain to the other. The surgery involves either partial or complete removal of the part of the brain connecting the nerves on the right and left sides of the brain, called the corpus callosum. This type of surgery can help prevent falls and injury in patients with more violent motor features.

• #21 Epilepsy – AANS

  https://www.aans.org/patients/conditions-treatments/epilepsy/

  While approximately 70 percent of patients have well-controlled seizures with these modalities, the remaining 30 percent do not and are considered medically-resistant. Patients with medically-resistant epilepsy are often treated at specialized epilepsy centers in a multi-disciplinary fashion. […] In patients whose seizures are medically resistant, surgery provides the best chance of complete control of seizures. However, not all patients with refractory epilepsy are suitable candidates for surgery. In addition to being refractory, they need to have partial, rather than generalized epilepsy (i.e. their epilepsy arises from a single part of the brain, rather than from both sides or from all over the brain). […] Improved technology and testing has made it possible to identify more accurately where seizures originate in the brain (epileptogenic regions), and advances in surgery have made operative management safer for all forms of surgery for epilepsy. Of the surgeries presented, surgical resection offers the best chance of rendering a patient seizure-free. However, the benefits of surgery should always be weighed carefully against its potential risks.

• #22 Epilepsy Treatment, Including Epilepsy Surgery – Emory Healthcare

  https://www.emoryhealthcare.org/centers-programs/epilepsy-center/epilepsy-treatment

  The Epilepsy Center offers traditional and innovative epilepsy treatments and services, including: […] The team of specialists at the Emory Epilepsy Center works with you to choose the right medications and make adjustments to gain full seizure control. […] Every anti-epileptic medication can produce side effects. Our clinicians will work closely with you to develop a treatment plan that provides the most significant seizure control with the fewest side effects. […] In these cases, epilepsy surgery is often the best chance of seizure control. […] Approximately 80 percent of patients with temporal lobe epilepsy (the single most common form of epilepsy) gain complete control of their seizures after surgery, while most of the remaining 20 percent report significant improvement. […] Another possible treatment option for those with drug resistant epilepsy is neurostimulation which provides electrical stimulation to the brain.

• #23 Epilepsy and Seizures Treatment & Management: Approach Considerations, Anticonvulsant Therapy, Anticonvulsants for Specific Seizure Types

  https://emedicine.medscape.com/article/1184846-treatment

  Several curative surgeries are possible, including lobectomy and lesionectomy. In general, the epileptogenic zone must be mapped by using video-electroencephalographic (video-EEG) monitoring and, in some patients, with intracranial electrodes. […] […] Outcomes of temporal-lobe surgeries are better than those for surgeries in other areas. If a patient has unilateral temporal-lobe seizures (as observed on video-EEG) and unilateral hippocampal sclerosis (as observed on brain magnetic resonance imaging [MRI]), the likelihood of a class I outcome (no seizures or only auras) at 2 years is about 85%. […] […] The major problem for patients with seizures is the unpredictability of the next seizure. Clinicians should discuss the following types of seizure precautions with patients who have epileptic seizures or other spells of sudden-onset seizures. […] […] In 2018, the FDA cleared for marketing the first smart watch for seizure tracking and epilepsy management. The Embrace smart watch identifies convulsive seizures and sends an alert via text and phone message to caregivers.

• #24 New treatment options for drug-resistant epilepsy – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/neurosciences-articles/new-treatment-options-for-people-with-drug-resistant-epilepsy

  Recently, minimally invasive epilepsy brain surgery has advanced quite significantly, particularly a procedure called laser ablation for patients with epilepsy. In that surgery, we insert a small laser fiber and burn away the seizure focus but dont have to open up the skull. […] Now we have neuromodulation or neurostimulation devices. The FDA has approved three different devices with well-defined benefits: vagal nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS). […] In general, VNS reduces seizures by about 50%. For RNS, the expectation is around 70% of seizure reduction. DBS has comparable benefit to RNS. All three devices do not cure epilepsy, but they improve the symptoms. […] Significant advances have been made in the last several decades. We are very excited about the minimally invasive surgery. This is a paradigm-shifting technique and may become the safe and effective alternative to the traditional open brain surgery for people with drug-resistant epilepsy.

• #25 Treatment Options – Epilepsy Foundation of Colorado and Wyoming

  https://epilepsycoloradowyoming.org/what-is-epilepsy/treatment-options/

  Neuromodulation is another option for controlling seizures. This therapy involves using a device to send small electrical currents to the nervous system. […] Medical marijuana (also called medical cannabis) is whole plant marijuana or extracts from the plant used for medical purposes. […] Evidence from laboratory studies, anecdotal reports, and small clinical studies over a number of years suggest that cannabidiol (CBD) could potentially help control seizures. The FDA recently approved the use of Epidiolex (a plant-based formulation of CBD) to treat seizures for people 2 years of age and older with Dravet syndrome and Lennox-Gastaut syndrome (LGS). […] When conventional treatments do not work to control seizures, as is the case for roughly 30% of people with epilepsy, it is not unreasonable to consider CBD oil.

• #26 New treatment options for drug-resistant epilepsy – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/neurosciences-articles/new-treatment-options-for-people-with-drug-resistant-epilepsy

  Recently, minimally invasive epilepsy brain surgery has advanced quite significantly, particularly a procedure called laser ablation for patients with epilepsy. In that surgery, we insert a small laser fiber and burn away the seizure focus but dont have to open up the skull. […] Now we have neuromodulation or neurostimulation devices. The FDA has approved three different devices with well-defined benefits: vagal nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS). […] In general, VNS reduces seizures by about 50%. For RNS, the expectation is around 70% of seizure reduction. DBS has comparable benefit to RNS. All three devices do not cure epilepsy, but they improve the symptoms. […] Significant advances have been made in the last several decades. We are very excited about the minimally invasive surgery. This is a paradigm-shifting technique and may become the safe and effective alternative to the traditional open brain surgery for people with drug-resistant epilepsy.

• #27 Epilepsy treatment | Epilepsy Society

  https://epilepsysociety.org.uk/about-epilepsy/treatment

  Brain surgery or neurosurgery is one way of treating epilepsy. This may involve removing a specific area of the brain which might have caused the epilepsy. Certain criteria have to be met and tests have to be done to assess suitability. […] Vagus nerve stimulation (VNS) therapy is a treatment for epilepsy that involves a stimulator (or 'pulse generator’) which is connected, inside the body, to the left vagus nerve in the neck. The stimulator sends regular, mild electrical stimulations through this nerve to help calm down the irregular electrical brain activity that leads to seizures. […] The ketogenic diet is one treatment option for children or adults with epilepsy whose seizures are not controlled with ASMs. The diet may help to reduce the number or severity of seizures and may have other positive effects.

• #28 Treatment Options: Implant Devices – Epilepsy Foundation of Minnesota

  https://www.epilepsyfoundationmn.org/resource/treatment-options-implant-devices/

  Implant devices are used to treat seizures in people with refractory or drug-resistant epilepsy. This means that their seizures are not controlled after trying two or more appropriate anti-seizure medications. Implants may be recommended for people for whom brain surgery to remove the area where the seizures start is not an option, or when surgery did not work. […] Implant devices can help to reduce the frequency and severity of seizures, but are not expected to stop seizures completely. Some people may be able to decrease the dosage of their medication, which may help reduce side effects. […] VNS Therapy is approved by the U.S. Food and Drug Administration (FDA) as an add-on therapy for adults and children 4 years and older. This means it is used in combination with anti-seizure medications.

• #29 Epilepsy Treatments

  https://www.froedtert.com/epilepsy/treatment

  Deep Brain Stimulation (DBS) is the latest treatment option for patients living with epilepsy. […] With DBS, a small neurostimulator is surgically placed under the skin to delivery therapy. […] RNS System This new treatment consists of an implanted neurostimulator that detects an impending seizure and delivers imperceptible electrical stimulation before it occurs. […] Vagus Nerve Stimulator The stimulator is implanted in the left side of the chest and connected to the Vagus nerve. […] Epilepsy Surgery Corrective surgery is conducted with the help of brain mapping including brain mapping during „awake” surgery. […] The program has also assisted more adult patients than any other Wisconsin hospital using the Vagus Nerve Stimulator.

• #30 Treatment Options: Implant Devices – Epilepsy Foundation of Minnesota

  https://www.epilepsyfoundationmn.org/resource/treatment-options-implant-devices/

  This therapy does not cure epilepsy, but is designed to help reduce the number and severity of seizures. Reduction in seizures typically improves over time, from an average reduction of 28% in the first three months to as much as a 75% decline in seizures after 10 years of use. […] RNS Therapy is approved by the FDA as an add-on therapy for adults 18 and older. This means it is used in combination with anti-seizure medications. […] This therapy does not cure epilepsy, but has been shown to reduce the number of seizures in most people. Studies have shown these results to improve over time, from an average reduction in seizures of 44% after one year, to 53% at two years, to 66% percent at three to six years. A long-term study showed a median seizure reduction of 75% after nine years. […] DBS is approved by the FDA as an add-on therapy for adults age 18 and up who have focal (partial) seizures. The individual will continue to take anti-seizure medications.

• #31 Natural remedies for epilepsy: Diet, herbs, vitamins, and more

  https://www.medicalnewstoday.com/articles/317922

  Vagus nerve stimulation (VNS) involves implanting a device in the chest that sends electrical signals to the brain. […] The effect of VNS varies widely among people with epilepsy. […] According to research from 2020, 5060% of those who undergo VNS for epilepsy may see a reduction in seizures of about 50% in 24 years, and 8% may stop having seizures entirely. […] For people with epilepsy, stress and anxiety may increase the risk of having a seizure. […] According to the Epilepsy Society, some relaxation techniques that may help include: Indian head massage, which is a massage of the head, shoulders, and arms; whole or partial body massage; shiatsu; acupressure. […] A 2023 review of research found that acupuncture may be useful for treating epilepsy alongside conventional treatment, like medications.

• #32 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/treatment/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you or your partner are taking epilepsy medicine and there’s a chance you could get pregnant it’s very important to discuss your treatment with a specialist. […] You might also need to change your medicine as some epilepsy medicines are not safe to take in pregnancy. […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #33 Epilepsy treatment | Epilepsy Society

  https://epilepsysociety.org.uk/about-epilepsy/treatment

  Brain surgery or neurosurgery is one way of treating epilepsy. This may involve removing a specific area of the brain which might have caused the epilepsy. Certain criteria have to be met and tests have to be done to assess suitability. […] Vagus nerve stimulation (VNS) therapy is a treatment for epilepsy that involves a stimulator (or 'pulse generator’) which is connected, inside the body, to the left vagus nerve in the neck. The stimulator sends regular, mild electrical stimulations through this nerve to help calm down the irregular electrical brain activity that leads to seizures. […] The ketogenic diet is one treatment option for children or adults with epilepsy whose seizures are not controlled with ASMs. The diet may help to reduce the number or severity of seizures and may have other positive effects.

• #34 Epilepsy | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy

  Some people are unable to get good seizure control despite trying a number of medications. […] If surgery can remove this tissue, seizures can often be significantly reduced or even stopped. […] The vagus nerve stimulator (VNS) is a device that is implanted in the upper chest, which regularly sends out electrical signals to the vagus nerve and brain. […] The ketogenic diet is a recognised and proven therapy for epilepsy and has been reported to reduce seizures in some people with poorly-controlled epilepsy. […] Dietary options for epilepsy have expanded in recent years to include the modified Atkins diet and the low-glycaemic index treatment diet. […] Complementary medicine therapies may help a person by improving overall health and wellbeing, which can also help improve seizure control.

• #35 Epilepsy Treatment for Seizures. What to do for epileptic seizure

  https://www.eftx.org/seizure-treatment/

  DBS may be used to treat people 18 years and older with uncontrolled focal seizures. Surgery is done to place the device, then it is programmed by an epilepsy specialist. DBS therapy is designed to change how brain cells or networks work by giving electrical stimulation to brain areas involved in seizures. […] A laser fiber is guided toward the source of a patients seizures through a small hole in the skull. The laser heats and destroys the small, well-defined area of abnormal brain tissue, leaving the surrounding tissue unharmed. […] The classic ketogenic diet, a special high-fat, low-carbohydrate diet, is prescribed and monitored by a physician and nutritionist to help control seizures in some people. It can help both children and adults with refractory seizures. […] The modified Atkins diet has some similarities to the traditional ketogenic diet, although it is less restrictive. It encourages eating fewer carbohydrates and more fats. Foods are not weighed and measured, but carbohydrates are monitored.

• #36 Epilepsy Treatment for Seizures. What to do for epileptic seizure

  https://www.eftx.org/seizure-treatment/

  The LGIT for epilepsy was developed in 2002 as an alternative to the ketogenic diet (KD) for treatment of intractable epilepsy. The LGIT monitors not only the total amount of carbohydrates consumed daily, but focuses on carbohydrates that are less likely to raise your blood sugar quickly, like whole grains and berries.

• #37 Epilepsy – AANS

  https://www.aans.org/patients/conditions-treatments/epilepsy/

  Epilepsy may be treated with antiepileptic medications (AEDs), diet therapy and surgery. Medications are the initial treatment choice for almost all patients with multiple seizures. Some patients who only have a single seizure and whose tests do not indicate a high likelihood of seizure recurrence may not need medications. The medications treat the symptoms of epilepsy (the seizures), rather than curing the underlying condition. They are highly effective and completely control seizures in the majority (approximately 70%) of patients. The drugs prevent seizures from starting by reducing the tendency of brain cells to send excessive and confused electrical signals. […] Diet therapy may be utilized in some patients with specific forms of epilepsy. The most common diets utilized are the ketogenic diet and the modified Atkins diet. The ketogenic diet is a special high-fat, adequate protein and low carbohydrate diet that is initiated over three to four days in the hospital. The modified Atkins diet is similar to the ketogenic diet but is slightly less restrictive. It can be initiated as an outpatient. Both diets have been shown to reduce seizures in approximately half the patients that are identified to be appropriate candidates. These are mainly children with refractory epilepsy who are not surgical candidates.

• #38 Epilepsy Treatment in Delhi, India | Causes & Symptoms

  https://www.maxhealthcare.in/our-specialities/neurology/conditions-treatments/epilepsy-treatment

  Max Institute of Neurosciences offers the following options to get the best treatment for epilepsy. […] A) Anti-Epileptic Drugs: This is usually the first treatment that the doctor will try to start to control the seizures. The aim is to control seizures as fully as possible, whilst minimising the side effects of the drugs. […] B) The Ketogenic Diet: It is usually considered for children when AEDs have not had a good effect on controlling seizures. It involves strict control of fat, protein and carbohydrate levels, and should always be done with the supervision of a specialist dietitian. […] C) Vagal Nerve Stimulation (VNS): This involves implanting devices to attempt to suppress the abnormal electrical activity that causes seizures. They can be considered for people when anti-epileptic drugs have failed to give control.

• #39 Alternative Treatments and Therapies for Epilepsy

  https://www.cureepilepsy.org/understanding-epilepsy/treatments-and-therapies/alternative-therapies-for-epilepsy/

  In addition to medication, devices, and surgery, epilepsy can be treated through alternative treatments like CBD or music therapy. […] A healthcare provider may suggest using alternative or complementary therapies in addition to conventional treatments to help manage your epilepsy. […] If you are thinking of using alternative therapies for epilepsy treatment, please discuss these treatments with your neurologist or healthcare provider to find out which therapies are safe and potentially helpful for you. […] The FDA has approved only one CBD product for medicinal usage, the prescription drug Epidiolex (cannabidiol). It has been approved to treat seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), and Tuberous Sclerosis Complex (TSC) in patients one year of age and older.

• #40 Complementary therapies | Epilepsy Society

  https://epilepsysociety.org.uk/living-epilepsy/wellbeing/complementary-therapies

  On this page we look at complementary therapies that some people may find helpful, as well as some that may make epilepsy worse. These therapies are not meant to replace treatment with anti-seizure medication. […] Complementary therapies may help to promote wellbeing and underlying health as well as reduce stress. As the term complementary suggests, these therapies may help alongside any anti-seizure medication (ASM) you may be taking. It is important not to change or stop your medication without consulting the doctor who treats your epilepsy, because this could increase the number or frequency of your seizures, or cause unwanted side effects. […] Some therapies can increase the risk of seizures. It is important to know as much as possible about your own epilepsy, and the complementary therapies you are interested in.

• #41 Complementary Therapies | Epilepsy FoundationFacebookInstagramTwitterPhoneEmailFacebookInstagramTwitter

  https://epilepsyfoundation.org.au/managing-epilepsy/health-and-wellbeing/complementary-therapies/

  It is important to remember that complementary therapies cannot cure or control epilepsy, and it is a good idea to discuss any of these approaches with your doctor before using them. They are also not an alternative to your regular treatment approach, and you should not stop taking your anti-epileptic medication if you choose to pursue using complementary therapies as well. […] Acupuncture, which is part of traditional Chinese medicine, uses needles and sometimes heat to stimulate nerve endings. The objective of acupuncture is to assist a person achieve better mental, physical and emotional wellbeing. […] Many types of massages are available. General massage therapy is offered by a masseuse, while manipulative therapy is provided by an osteopath or chiropractor. Massage is often used to reduce tension, assist with relaxation and minimise stress.

• #42 Complementary therapies | Epilepsy Society

  https://epilepsysociety.org.uk/living-epilepsy/wellbeing/complementary-therapies

  Massage therapy can generally be safe and even beneficial for people with epilepsy but stress, over-stimulation, or other factors during a massage session may potentially trigger a seizure. Always talk to your epilepsy doctor before trying any complementary therapy and let the therapist know about your epilepsy and triggers. […] It is thought that some essential oils may trigger seizures, and so are not recommended for use by people with epilepsy. […] There are a number of essential oils that are known to have a calming and relaxing effect. If someones seizures are triggered by stress, then using these oils to relax may help to reduce seizures. […] Reflexology can be helpful in reducing stress and making you feel relaxed, and can support wellbeing and underlying health. […] Relaxing activities such as meditation, visualisation, yoga, or slow, focused breathing can help reduce stress and so help to reduce seizures for some people.

• #43 Complementary Therapies | Epilepsy FoundationFacebookInstagramTwitterPhoneEmailFacebookInstagramTwitter

  https://epilepsyfoundation.org.au/managing-epilepsy/health-and-wellbeing/complementary-therapies/

  Living with epilepsy and managing its impacts often involves more than just gaining seizure control. Finding a good quality of life is important, and for some people this can be helped through the use of complementary therapies. However, it is important to remember that complementary therapies should never replace use of anti-epileptic drugs (ASMs). […] Stress, anxiety, and lack of sleep can be seizure triggers for some people with epilepsy. In some cases, the use of complementary therapies may have a positive effect on these symptoms, and therefore potentially help reduce seizure activity. Some common complementary therapies include acupuncture, massage, aromatherapy, relaxation techniques (yoga and meditation), homeopathy, and herbal medicine. […] At this stage there is limited scientific evidence of the effectiveness of complementary therapy on epilepsy. However, some people living with epilepsy have reported that using complementary therapies has assisted them to achieve a better quality of life and feel it has assisted in seizure management. On the other hand, some people have had adverse reactions and increased seizure activity when using complementary therapies.

• #44 Complementary therapies | Epilepsy Society

  https://epilepsysociety.org.uk/living-epilepsy/wellbeing/complementary-therapies

  There is a lack of evidence for their benefit, but that does not mean that some herbal medicine may not benefit some people. […] Medicines containing herbs such as schizandra, kava kava and comfrey may increase seizures for some people. […] Although there is no evidence that homeopathic treatments directly help epilepsy, such an individual approach may help people feel better generally, and more in control of their epilepsy. […] It can also improve wellbeing and underlying health. […] Although there has been no evidence that acupuncture can directly help a persons epilepsy, it has been found to be effective in reducing stress and anxiety, which may then result in fewer seizures for some people with epilepsy. […] Psychological therapies may include relaxation techniques to release the tension in your body and relax your muscles. Behaviour modification therapy is another psychological approach. Relaxation therapy combined with behaviour modification therapy is used for both children and adults. There is evidence that they may help some people feel less anxious, and can also help them adjust to having epilepsy. Research suggests that psychological therapies may improve wellbeing in people with epilepsy.

• #45 Complementary Therapies | Epilepsy FoundationFacebookInstagramTwitterPhoneEmailFacebookInstagramTwitter

  https://epilepsyfoundation.org.au/managing-epilepsy/health-and-wellbeing/complementary-therapies/

  Aromatherapy uses pure essential oils from plants, usually selected for a range of effects including relaxation, stress reduction or to aid in healing. […] Some people use yoga and meditation to relax, unwind, practice mindfulness and reduce stress. Some people with epilepsy have found that relaxation techniques can ease tension and stress, and reduce stress-related seizure triggers. […] Herbal medicine is easily accessed in pharmacies or through homoeopathists. Even though herbal medicines are often promoted as being ‘natural’ or as a ‘dietary supplement’, they may cause seizures because of negative interactions with ASMs. […] The complementary therapy industry in Australia is largely self-regulated, with some exceptions. […] Complementary medicines made in Australia are subject to strict product safety and quality regulations through the Australian Government’s Therapeutic Goods Administration (TGA).

• #46 Natural remedies for epilepsy: Diet, herbs, vitamins, and more

  https://www.medicalnewstoday.com/articles/317922

  Knowing and avoiding their triggers may help people reduce the risk of experiencing a seizure. […] Learning about epilepsy may improve quality of life for people who have seizures and their families. […] For many alternative and natural remedies, there is some research and anecdotal evidence to support their use. However, there are not enough scientific studies to prove that they work. […] Most importantly, people should always talk with a doctor before trying natural treatments to help ease their symptoms.

• #47 Complementary therapies | Epilepsy Society

  https://epilepsysociety.org.uk/living-epilepsy/wellbeing/complementary-therapies

  On this page we look at complementary therapies that some people may find helpful, as well as some that may make epilepsy worse. These therapies are not meant to replace treatment with anti-seizure medication. […] Complementary therapies may help to promote wellbeing and underlying health as well as reduce stress. As the term complementary suggests, these therapies may help alongside any anti-seizure medication (ASM) you may be taking. It is important not to change or stop your medication without consulting the doctor who treats your epilepsy, because this could increase the number or frequency of your seizures, or cause unwanted side effects. […] Some therapies can increase the risk of seizures. It is important to know as much as possible about your own epilepsy, and the complementary therapies you are interested in.

• #48 Alternative Treatments and Therapies for Epilepsy

  https://www.cureepilepsy.org/understanding-epilepsy/treatments-and-therapies/alternative-therapies-for-epilepsy/

  In addition to medication, devices, and surgery, epilepsy can be treated through alternative treatments like CBD or music therapy. […] A healthcare provider may suggest using alternative or complementary therapies in addition to conventional treatments to help manage your epilepsy. […] If you are thinking of using alternative therapies for epilepsy treatment, please discuss these treatments with your neurologist or healthcare provider to find out which therapies are safe and potentially helpful for you. […] The FDA has approved only one CBD product for medicinal usage, the prescription drug Epidiolex (cannabidiol). It has been approved to treat seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), and Tuberous Sclerosis Complex (TSC) in patients one year of age and older.

• #49 Alternative Treatments and Therapies for Epilepsy

  https://www.cureepilepsy.org/understanding-epilepsy/treatments-and-therapies/alternative-therapies-for-epilepsy/

  In addition to medication, devices, and surgery, epilepsy can be treated through alternative treatments like CBD or music therapy. […] A healthcare provider may suggest using alternative or complementary therapies in addition to conventional treatments to help manage your epilepsy. […] If you are thinking of using alternative therapies for epilepsy treatment, please discuss these treatments with your neurologist or healthcare provider to find out which therapies are safe and potentially helpful for you. […] The FDA has approved only one CBD product for medicinal usage, the prescription drug Epidiolex (cannabidiol). It has been approved to treat seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), and Tuberous Sclerosis Complex (TSC) in patients one year of age and older.

• #50 Natural remedies for epilepsy: Diet, herbs, vitamins, and more

  https://www.medicalnewstoday.com/articles/317922

  In 2020, the Food and Drug Administration (FDA) approved Epidiolex, which is a drug containing a cannabis-based ingredient, to treat seizures that stem from two rare and severe genetic conditions: Lennox-Gastaut syndrome and Dravet syndrome. […] This is currently the only cannabis-based product with FDA approval, and it is only available with a prescription. […] However, larger scientific studies have not shown that cannabis and most CBD-based products are effective in treating epilepsy. […] There is also a risk of serious side effects, including worsening epilepsy or interactions with antiepileptic drugs or other medications. […] For this reason, people should speak with a doctor before using these substances. […] There is some evidence to suggest that a ketogenic, or keto, diet which is a high fat, low carbohydrate diet could help prevent seizures in people who do not find antiepileptic drugs effective.

• #51 New Trends and Most Promising Therapeutic Strategies for Epilepsy Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8690245/

  A search on PubMed, Scopus, and EMBASE databases using the terms epilepsy, treatment or therapy, and novel was conducted. […] Precision medicine (PM) is an outstanding approach tended to use the genetics, environment, and lifestyle of individuals to help determine the best way to prevent or treat disease. […] Nowadays, evidence indicates PM may be applied to individuals with both rare and common forms of epilepsy, and, consequently, drug development is increasingly being influenced by PM approaches. […] Many medications are currently under study in clinical practice, ranging from those with a mechanism similar to that of well-known ASMs, like the GABA-A receptor agonists, to those with novel mechanisms such as the stimulation of melatonin receptors. […] Cannabidiol is approved for the treatment of seizures in children with DS or Lennox-Gastaut syndrome (LGS) aged 2 years or older, based on three pivotal phases 3 trials.

• #52 Alternative Treatments and Therapies for Epilepsy

  https://www.cureepilepsy.org/understanding-epilepsy/treatments-and-therapies/alternative-therapies-for-epilepsy/

  If you currently take CBD or are thinking about taking CBD for epilepsy treatment, be sure to discuss this with your neurologist or healthcare provider, who can guide you to determine which products are safe or unsafe for you to use. […] No other CBD products have been evaluated to see if they are safe to use or effective at treating epilepsy. […] Your healthcare provider can help you decide if Epidiolex is appropriate for you. […] Patients with various medical conditions have benefitted from music therapy, and many researchers have studied its impact on patients with epilepsy. […] While the effects of music on epilepsy control were not consistent, there have been examples of clinical trials in which patients experienced seizures less frequently when treated with music therapy. […] In one of the earliest studies on music therapy for epilepsy, the researchers chose Mozarts sonata for two pianos in D major (also known as K. 448) as the music for patients. […] The term Mozart Effect was coined to describe the phenomenon. […] Since then, many studies have used the same sonata, K. 448, to investigate the connection between music and seizure control.

• #53 Natural remedies for epilepsy: Diet, herbs, vitamins, and more

  https://www.medicalnewstoday.com/articles/317922

  In 2020, the Food and Drug Administration (FDA) approved Epidiolex, which is a drug containing a cannabis-based ingredient, to treat seizures that stem from two rare and severe genetic conditions: Lennox-Gastaut syndrome and Dravet syndrome. […] This is currently the only cannabis-based product with FDA approval, and it is only available with a prescription. […] However, larger scientific studies have not shown that cannabis and most CBD-based products are effective in treating epilepsy. […] There is also a risk of serious side effects, including worsening epilepsy or interactions with antiepileptic drugs or other medications. […] For this reason, people should speak with a doctor before using these substances. […] There is some evidence to suggest that a ketogenic, or keto, diet which is a high fat, low carbohydrate diet could help prevent seizures in people who do not find antiepileptic drugs effective.

• #54 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine

  https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people

  Dr. Hirsch and other Yale Medicine epilepsy specialists answered questions about the latest approaches and advances in refractory epilepsy treatment and how they are giving more patients a better quality of life—and, in some cases, providing a cure. […] Medication is still the first line of treatment for epilepsy. […] While drugs won’t cure epilepsy, they allow an estimated 70% of people with the condition to manage it to the point where it barely interferes with their daily life. […] Epilepsy surgery might be considered if two or more anti-seizure medications (without significant side effects) are tried and don’t stop the seizures, giving the condition the classification of refractory epilepsy. […] The goal of surgery is to identify and target the area (or areas) in the brain causing the seizures and remove or otherwise disable it, without harming nearby areas that regulate important functions, such as speech or memory.

• #55 New treatment options for drug-resistant epilepsy – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/neurosciences-articles/new-treatment-options-for-people-with-drug-resistant-epilepsy

  An estimated 65 million people worldwide have epilepsy, and one in 26 Americans will develop epilepsy in their lifetime. Most of these people are able to control their seizures with medications, but approximately 30% to 40% have whats called drug-resistant or medically refractory epilepsy, in which they dont respond to standard anti-seizure medications. […] As a neurologist who specializes in the diagnosis and management of epilepsy, I am very excited about the recent development of new treatment options for people with drug-resistant epilepsy, particularly minimally invasive epilepsy surgery and neuromodulation treatment. […] There are a few options available for people with drug-resistant epilepsy. The most common one is epilepsy surgery, which has been performed since the 1940s. It is a well-established and effective procedure. Traditional epilepsy surgery is open brain surgery. For a patient with focal epilepsy, where the seizures are being caused by one part of the brain, you try to remove the seizure focus. Somewhere between 60% and 70% of patients with drug-resistant epilepsy who have this surgery become seizure-free, which is the standard of care if the medications were not to work. So, any patient who has drug-resistant epilepsy should be evaluated for surgery.

• #56 Focal (Partial) Epilepsy Treatment & Management: Approach Considerations, Antiseizure Medication Therapy, Surgical Care

  https://emedicine.medscape.com/article/1186635-treatment

  Approximately 30%40% of patients with focal epilepsy become intractable despite the use of anti-seizure medications (ASMs). […] Several clinical trials have shown the efficacy of surgical over medical treatment for drug-resistant epilepsy, therefore referral of such patients to a qualified epilepsy center is paramount. […] Resective surgery remains the gold standard and may include variations such as callosotomy, hemispherectomy, and functional disconnection surgeries. […] Neuromodulation devices can serve as a reasonable adjunctive therapy for intractable focal epilepsy in such cases where resection is too high-risk for neurologic injury. […] Consider the ketogenic diet or a modified Atkins diet as an alternative therapy for epileptic seizures. It is effective, even in highly refractory cases, but very strict; compliance may be extremely cumbersome. […] If seizures are refractory to the first 23 trials of medication, refer patients to a comprehensive epilepsy center to evaluate other treatment options.

• #57 The Future of Epilepsy Treatment: Here’s What We Know

  https://www.uchealth.com/en/media-room/articles/treating-epilepsy-now-and-in-the-future

  Here is what you need to know about epilepsy and the types of treatments that are available for it. […] When someone has two unprovoked seizures, or a single seizure with a high risk of having another seizure, treatment with anti-seizure medications is usually started. […] About half of the people treated with epilepsy will respond well to the first medication. A smaller percentage will have complete seizure control on the second medication. […] Once a person has failed to get complete seizure control on two different medications, the likelihood that additional medications will stop the seizures is usually less than 10%. […] If a patient fails to get complete control of seizures after trials of two appropriately chosen medications, its referred to as medication resistant or refractory epilepsy.

• #58 The Future of Epilepsy Treatment: Here’s What We Know

  https://www.uchealth.com/en/media-room/articles/treating-epilepsy-now-and-in-the-future

  Its been recommended that all patients with medication-resistant epilepsy should get advanced evaluation at an epilepsy center. […] The key element of an epilepsy center is usually an inpatient epilepsy monitoring unit, or EMU. […] This allows precise mapping of the part of the brain where seizures start as well as the patterns that seizures spread throughout the brain. […] In some people with epilepsy who have not responded to medication, surgical treatment can provide a very effective and safe option. […] Traditional epilepsy surgery involves precise mapping of the area of the brain where seizures start, and then additional mapping to be sure that removing that portion of the brain would not adversely affect speech, memory, movement, sensation or other critical brain functions. […] Over the last several decades, epilepsy surgery has become more effective and safer than ever before.

• #59 New treatment options for drug-resistant epilepsy – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/neurosciences-articles/new-treatment-options-for-people-with-drug-resistant-epilepsy

  Recently, minimally invasive epilepsy brain surgery has advanced quite significantly, particularly a procedure called laser ablation for patients with epilepsy. In that surgery, we insert a small laser fiber and burn away the seizure focus but dont have to open up the skull. […] Now we have neuromodulation or neurostimulation devices. The FDA has approved three different devices with well-defined benefits: vagal nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS). […] In general, VNS reduces seizures by about 50%. For RNS, the expectation is around 70% of seizure reduction. DBS has comparable benefit to RNS. All three devices do not cure epilepsy, but they improve the symptoms. […] Significant advances have been made in the last several decades. We are very excited about the minimally invasive surgery. This is a paradigm-shifting technique and may become the safe and effective alternative to the traditional open brain surgery for people with drug-resistant epilepsy.

• #60 The Future of Epilepsy Treatment: Here’s What We Know

  https://www.uchealth.com/en/media-room/articles/treating-epilepsy-now-and-in-the-future

  Its been recommended that all patients with medication-resistant epilepsy should get advanced evaluation at an epilepsy center. […] The key element of an epilepsy center is usually an inpatient epilepsy monitoring unit, or EMU. […] This allows precise mapping of the part of the brain where seizures start as well as the patterns that seizures spread throughout the brain. […] In some people with epilepsy who have not responded to medication, surgical treatment can provide a very effective and safe option. […] Traditional epilepsy surgery involves precise mapping of the area of the brain where seizures start, and then additional mapping to be sure that removing that portion of the brain would not adversely affect speech, memory, movement, sensation or other critical brain functions. […] Over the last several decades, epilepsy surgery has become more effective and safer than ever before.

• #61 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/treatment/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you or your partner are taking epilepsy medicine and there’s a chance you could get pregnant it’s very important to discuss your treatment with a specialist. […] You might also need to change your medicine as some epilepsy medicines are not safe to take in pregnancy. […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #62 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. Do not change your dose or stop taking your medicine without talking to your specialist. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #63 Epilepsy medicines – Epilepsy Action

  https://www.epilepsy.org.uk/info/treatment/anti-seizure-medication

  The main treatment for epilepsy is taking epilepsy medicines. They are also known as epilepsy medication, anti-seizure medications (ASMs) or anti-epileptic drugs (AEDs). […] They dont cure epilepsy, but try to prevent seizures from happening. They do this by changing the levels of chemicals in the brain that control electrical activity. […] Deciding whether to take epilepsy medicines or not should be a joint decision between you and your specialist. If you need help deciding, the specialist should also involve your family or carer. […] There are many different epilepsy medicines available. When the specialist is deciding which one will best suit you, they will consider things like: The types of seizure you have, as some medicines are only effective for certain types of seizure. […] Research has shown that some epilepsy medicines could be harmful to an unborn baby if taken during pregnancy.

• #64 The pharmacological treatment of epilepsy: recent advances and future perspectives | Acta Epileptologica | Full Text

  https://aepi.biomedcentral.com/articles/10.1186/s42494-021-00055-z

  The findings from the SANAD studies that valproate is superior to lamotrigine, topiramate and levetiracetam in the treatment of patients with generalized epilepsy are consistent with other lines of evidence. […] The superior efficacy of valproate in controlling seizures associated with generalized epilepsy, however, creates a dilemma in the treatment of females of childbearing potential. […] With respect to teratogenic potential of ASMs, prospective pregnancy registries have contributed greatly to characterize risks associated with individual medications. […] An increased risk with increasing dose was identified for lamotrigine and carbamazepine, and was most prominent for phenobarbital and valproate. […] The introduction of ASMs for orphan indications is a novel development, made possible by increased awareness of the unmet needs associated with many rare epilepsies and by regulatory incentives to develop drugs for these indications, particularly for children.

• #65 Antiseizure medicines for management of epilepsy in adults and children

  https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/epilepsy-and-seizures/antiseizure-medicines-for-management-of-epilepsy-in-adults-and-children

  Monotherapy with lamotrigine or levetiracetam, or valproic acid (sodium valproate), should be offered as first-line treatment for generalized onset seizures in men/boys and women/girls who are not of childbearing potential. […] In women and girls of childbearing potential with generalized onset seizures, lamotrigine or levetiracetam should be offered as first-line monotherapy. […] If the first monotherapy is not successful for generalized onset seizures, an alternative first-line monotherapy should be tried. […] Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy. […] If the first monotherapy is not successful for focal onset seizures, an alternative first-line monotherapy should be tried.

• #66 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/treatment/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you or your partner are taking epilepsy medicine and there’s a chance you could get pregnant it’s very important to discuss your treatment with a specialist. […] You might also need to change your medicine as some epilepsy medicines are not safe to take in pregnancy. […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #67 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/

  If you have not had a seizure for 2 years, your specialist may suggest you try stopping your treatment by gradually reducing the dose. Do not change your dose or stop taking your medicine without talking to your specialist. […] For most people medicines work well to prevent seizures. Rarely, you may need other treatments. These can include: surgery on your brain, putting a small electrical device under the skin on your chest to help reduce seizures (vagus nerve stimulation), a specialist diet that can reduce seizures (ketogenic diet). […] If you’re planning to get pregnant or you find out you’re pregnant, keep taking your medicine but speak to your specialist team straight away to review your treatment.

• #68 New Trends and Most Promising Therapeutic Strategies for Epilepsy Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8690245/

  Background: Despite the wide availability of novel anti-seizure medications (ASMs), 30% of patients with epilepsy retain persistent seizures with a significant burden in comorbidity and an increased risk of premature death. This review aims to discuss the therapeutic strategies, both pharmacological and non-, which are currently in the pipeline. […] The common feature linking all the novel therapeutic approaches is the spasmodic rush toward precision medicine, aiming at holistically evaluating patients, and treating them accordingly as a whole. Toward this goal, different forms of intervention may be embraced, starting from the choice of the most suitable drug according to the type of epilepsy of an individual or expected adverse effects, to the outstanding field of gene therapy. Moreover, innovative insights come from in-vitro and in-vivo studies on the role of inflammation and stem cells in the brain. Further studies on both efficacy and safety are needed, with the challenge to mature evidence into reliable assets, ameliorating the symptoms of patients, and answering the challenges of this disease.

• #69 The pharmacological treatment of epilepsy: recent advances and future perspectives | Acta Epileptologica | Full Text

  https://aepi.biomedcentral.com/articles/10.1186/s42494-021-00055-z

  Extensive research is ongoing in many areas, and important advances leading to improved epilepsy outcomes are likely to occur in a not too distant future. […] In recent years, information technology (IT)-based applications have been increasingly utilized in epilepsy management. […] Smartphone applications (apps) are also being increasingly used to assist people with epilepsy to manage and cope with their disease. […] In recent years, our understanding of the molecular mechanisms involved in the pathogenesis of epilepsies has improved considerably. […] The elucidation of an epileptogenic mutation permits to establish the functional abnormality responsible for the epilepsy in the affected individual, and to identify (or develop) precision-therapy medications that may be able to correct such abnormality.

• #70 New Trends and Most Promising Therapeutic Strategies for Epilepsy Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8690245/

  Fenfluramine has been approved by the FDA in June 2020 and is currently under evaluation by the European Medicines Agency (EMA). […] Cenobamate (Xcopri or YKP3089) is a new ASM that has recently gained approval by the FDA for the treatment of focal-onset seizures in adults. […] Vagal nerve stimulation (VNS) is approved both in Europe and in the United States as an adjunctive treatment in patients with refractory epilepsies, and it is routinely available in many epilepsy centers, with more than 100,000 patients treated worldwide. […] Neuroinflammatory pathways as treatment targets and biomarkers in epilepsy. […] The Interleukin IL-1R1-TLR4 signaling pathway originates the neuroinflammatory cascade in epilepsy through increased levels of either the endogenous agonists or their receptors, or even a combination of both.

• #71 New Trends and Most Promising Therapeutic Strategies for Epilepsy Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8690245/

  Currently lying at the preclinical evidence, gene-based therapy modulates gene expression by introducing exogenous nucleic acids into target cells. […] Recurrent seizures are associated with the loss of inhibitory GABAergic interneurons. […] A variety of drugs are being investigated for the treatment of epilepsy, many of whom target previously neglected pathophysiological pathways but demonstrate a favorable efficacy profile, together with low to mild grade AEs. […] Cannabidiol, FFA, and cenobamate have been shown to efficiently control seizures and are generally well-tolerated; particularly, an increase in the number of seizure-free days was observed with positive outcomes on the QoL of patients.

• #72 New Trends and Most Promising Therapeutic Strategies for Epilepsy Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8690245/

  A search on PubMed, Scopus, and EMBASE databases using the terms epilepsy, treatment or therapy, and novel was conducted. […] Precision medicine (PM) is an outstanding approach tended to use the genetics, environment, and lifestyle of individuals to help determine the best way to prevent or treat disease. […] Nowadays, evidence indicates PM may be applied to individuals with both rare and common forms of epilepsy, and, consequently, drug development is increasingly being influenced by PM approaches. […] Many medications are currently under study in clinical practice, ranging from those with a mechanism similar to that of well-known ASMs, like the GABA-A receptor agonists, to those with novel mechanisms such as the stimulation of melatonin receptors. […] Cannabidiol is approved for the treatment of seizures in children with DS or Lennox-Gastaut syndrome (LGS) aged 2 years or older, based on three pivotal phases 3 trials.

• #73 The pharmacological treatment of epilepsy: recent advances and future perspectives | Acta Epileptologica | Full Text

  https://aepi.biomedcentral.com/articles/10.1186/s42494-021-00055-z

  At present, application of precision therapies in the management of epilepsy is still in its early days, and will likely expand as further knowledge accrues and newer and more effective targeted treatments are introduced. […] The search for biomarkers continues to be a hot topic in epilepsy research. […] Biomarkers could potentially be used for different purposes, for example to improve diagnostic accuracy, to identify ongoing epileptogenesis and its mechanisms, to predict seizure response (or lack of response) to specific treatments, to assess the probability of seizure recurrence after treatment withdrawal, or to evaluate susceptibility to adverse drug effects. […] The modest impact of second-generation ASMs on seizure outcome in patients resistant to older agents justifies continuing efforts to develop newer and potentially more effective treatments.

• #74 Epilepsy Treatment | Rush

  https://www.rush.edu/services/epilepsy-care

  At Rush, we look beyond seizure control, helping our patients address the psychological and emotional issues including depression and anxiety that are often associated with epilepsy. […] Our epilepsy team understands and takes these issues into account when developing your treatment plan, and we work with you to make adjustments, as needed, throughout your life. […] If you want children and are ready to start your family, our team will make sure you understand the challenges you may face and come up with a plan to address them. […] At Rush University Medical Center, we offer a dietary therapy clinic for adults to help you control seizures. […] Our neurologists can confirm your epilepsy diagnosis and point you to potential new treatment options for uncontrolled seizures. […] Researchers at Rush are investigating new epilepsy treatments.

• #75 Principles of Therapy in Epilepsies – The Epilepsies – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2607/

  The aim of therapy in epilepsies is total seizure freedom without clinically significant adverse effects. This is achievable in more than two-thirds of patients with epileptic seizures. […] Antiepileptic drug treatment is the mainstay of management of epilepsies. The decision to treat is based on a careful evaluation of the balance between the likelihood of further seizures and the risk of adverse effects of treatment. […] The laudable goal of AED treatment in epilepsies is to abolish seizures completely (freedom of seizures) with minimal if any drug-related adverse reactions. This is achieved in around 50-70% of patients with a single appropriately selected AED at target therapeutic doses. […] Freedom of seizures should not be pursued at any cost and, in particular, at the expense of drug-induced adverse reactions.

• #76 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/

  Epilepsy is a condition that affects your brain and causes seizures (sometimes called fits). It cannot currently be cured, but treatment can often help manage it. […] If you have epilepsy you’ll be supported by your GP and a team of specialists. You’ll have check-ups at least once a year. […] Your team will work with you to agree a care plan that includes details of the care and support you need. The care plan will tell your family or carers what to do when you have a seizure. […] The main treatment for epilepsy is medicine to prevent seizures, called anti-epileptic or anti-seizure medicine. […] You may also be given medicine to use as emergency treatment if you have a seizure that lasts longer than usual. A family member or carer will need to give this to you. […] There are different anti-epileptic medicines. The medicine recommended for you depends on the type of seizures and things like your age, sex and any other conditions you have.

• #77 Epilepsy Treatment | Rush

  https://www.rush.edu/services/epilepsy-care

  At Rush, we look beyond seizure control, helping our patients address the psychological and emotional issues including depression and anxiety that are often associated with epilepsy. […] Our epilepsy team understands and takes these issues into account when developing your treatment plan, and we work with you to make adjustments, as needed, throughout your life. […] If you want children and are ready to start your family, our team will make sure you understand the challenges you may face and come up with a plan to address them. […] At Rush University Medical Center, we offer a dietary therapy clinic for adults to help you control seizures. […] Our neurologists can confirm your epilepsy diagnosis and point you to potential new treatment options for uncontrolled seizures. […] Researchers at Rush are investigating new epilepsy treatments.

• #78 Epilepsy

  https://www.nhs.uk/conditions/epilepsy/

  Epilepsy is a condition that affects your brain and causes seizures (sometimes called fits). It cannot currently be cured, but treatment can often help manage it. […] If you have epilepsy you’ll be supported by your GP and a team of specialists. You’ll have check-ups at least once a year. […] Your team will work with you to agree a care plan that includes details of the care and support you need. The care plan will tell your family or carers what to do when you have a seizure. […] The main treatment for epilepsy is medicine to prevent seizures, called anti-epileptic or anti-seizure medicine. […] You may also be given medicine to use as emergency treatment if you have a seizure that lasts longer than usual. A family member or carer will need to give this to you. […] There are different anti-epileptic medicines. The medicine recommended for you depends on the type of seizures and things like your age, sex and any other conditions you have.

• #79 Principles of Therapy in Epilepsies – The Epilepsies – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2607/

  The drug treatment of epilepsies requires thorough knowledge of the AEDs with regard to mechanisms, pharmacokinetics, doses, indications, drug interactions and acute and chronic adverse effects. […] It is also fundamental to remember that special groups of patients with epileptic disorders require particular attention and management. […] The decision to commence AED treatment needs thorough consideration and should not be a knee-jerk reaction to a crisis about a dramatic convulsive event. […] The aim of AED medication should be truly to treat and not just to medicate those in need of AEDs. […] Treatment should be initiated if the risks of further seizures outweigh the risks of adverse reactions induced from AED medication. […] An antiepileptic drug appropriate for one type of seizure may be deleterious for another type of seizure. The selected antiepileptic drug should be the most likely to be effective and the most unlikely to cause adverse reactions.

• #80 Epilepsy: Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0715/p87.html

  Early initiation of AED therapy may reduce the risk of sudden unexpected death in epilepsy (SUDEP), which is death in a person with epilepsy in whom no other cause of death is found. […] Choice of AED should be individualized in consultation with a neurologist, and based on factors such as seizure type, presence of an epilepsy syndrome, other medications, comorbidities, lifestyle, and patient preference. […] Monotherapy with all indicated AEDs should be attempted before initiating combination therapy. […] Up to 30% of patients with epilepsy can have medically refractory epilepsy. These patients have continued seizures despite appropriate AED therapy. Surgical resection of the seizure focus in appropriately selected patients often results in decreased frequency or elimination of seizures with improvement in quality of life.

• #81 Principles of Therapy in Epilepsies – The Epilepsies – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK2607/

  The selected drug should not be abandoned prior to achieving recommended target doses unless unacceptable side effects occur, it is ineffective or exaggeration of seizures occurs. […] Monotherapy with an appropriately selected AED at an appropriate target dose achieves complete control of seizures in 50-70% of patients. […] Rational polytherapy is often needed for 30-50% of patients with epilepsies who are unsatisfactorily controlled with a single AED. […] The surgical treatment of drug-resistant epilepsy has become increasingly more valuable and often life saving due to major advances in structural and functional neuroimaging, EEG monitoring and surgical techniques. […] VNS is an invasive non-pharmacological treatment licensed since 1997 for drug-resistant focal epilepsy with or without secondarily GTCS in patients over the age of 12 years.

• #82 Epilepsy and Seizures Treatment & Management: Approach Considerations, Anticonvulsant Therapy, Anticonvulsants for Specific Seizure Types

  https://emedicine.medscape.com/article/1184846-treatment

  In general, neonates and children require similar loading doses per kilogram of body weight, but they tend to metabolize the drugs faster than adults. This younger population also has rapid increases in the total volume of distribution. […] […] After a person has been seizure free for typically 2-5 years, the physician may consider discontinuing that patients medication. Many patients outgrow many epileptic syndromes of childhood and do not need to take anticonvulsants. […] […] A ketogenic or modified Atkins diet and vagal nerve stimulation (VNS) are nonpharmacologic methods for managing patients with seizures that are unresponsive to antiepileptic drugs. The ketogenic diet is typically used in children. […] […] VNS is a palliative technique that involves surgical implantation of a stimulating device. VNS is FDA approved to treat medically refractory focal-onset epilepsy in patients older than 12 years. […]

• #83 Overview of the management of epilepsy in adults – UpToDate

  https://www.uptodate.com/contents/overview-of-the-management-of-epilepsy-in-adults

  INTRODUCTION AND APPROACH TO TREATMENT […] The management of patients with epilepsy is focused on three main goals: controlling seizures, avoiding treatment adverse effects, and maintaining or restoring quality of life. Clinicians should assist in empowering patients with epilepsy to lead lifestyles consistent with their capabilities. […] The optimal treatment plan is derived from an accurate diagnosis of the patient’s seizure type(s), an objective measure of the intensity and frequency of the seizures, awareness of medication adverse effects, and an evaluation of disease-related psychosocial problems. A working knowledge of available antiseizure medications (ASMs), including their mechanisms of action, pharmacokinetics, drug-drug interactions, and adverse effects, is essential. […] It is usually appropriate to refer the patient to a neurologist when establishing a diagnosis and formulating a course of treatment. Referral to an epilepsy specialist may be necessary if there is doubt about the diagnosis and/or if the patient continues to have seizures.

• #84 Epilepsy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093

  The best care starts with an accurate diagnosis. The medications we have for epilepsy are incredibly effective. More than half of the cases are seizure-free after their first medication. But when medication does not work at stopping seizures completely, there are other emerging ways of treating epilepsy, including surgery and brain stimulation. […] Treatment with medicines or sometimes surgery can control seizures for most people with epilepsy. Some people require lifelong treatment. For others, seizures go away. Some children with epilepsy may outgrow the condition with age. […] Knowing the kind of seizure you have is key to treatment.

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