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On the Frontline of Epilepsy Treatment

Treatments for epilepsy have come a long way in the last decade. Doctors have more than twice as many epilepsy medications to choose from now than they did 10 years ago. They've learned more about the causes of the condition and developed whole new methods of treatment, like nerve stimulation. There has been a lot of progress, and even more new medications and treatments are being tested now.

This all adds up to a good prognosis for the 2.5 million people with epilepsy in the U.S. With proper treatment, most people with epilepsy can live healthy lives without seizures.

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Some parents of children with epilepsy are skeptical of the ketogenic diet when they first hear about it. A diet that can control epilepsy and stop seizures without any medication? It almost sounds like a scam. But the ketogenic diet is real and legitimate. It works very well in many people. The catch is that it's extremely demanding and difficult to follow. In fact, it is so difficult to follow that most doctors recommend it only for people who haven't been able to control their seizures...

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To find out the current state of epilepsy treatment, WebMD talked to Gregory L. Barkley, MD, chairman of the Epilepsy Foundation's Professional Advisory Board. Barkley also practices at the Henry Ford Hospital in Detroit and is an associate professor of neurology at Case Western Reserve University in Cleveland.

What Can Someone With Epilepsy Expect From Treatment Today?

The expectation for people with epilepsy is that they should be free of seizures but not on a dose of medication that gives them unacceptable side effects. That's what we're aiming for: no seizures, no side effects. If you're still having seizures or side effects with treatment, then you have to seek expert care.

What's the Most Common Treatment for Epilepsy?

Medication remains the most common treatment for people with epilepsy. There are about a dozen drugs now. Most epilepsy syndromes and the vast majority of genetic syndromes that cause seizures are adequately treated with existing medication. The good news is that if they get identified properly and are prescribed the right kind of medication, most people with epilepsy will do well.

But the bad news is that many doctors don't recognize specific epilepsy syndromes and don't use the right medication to treat them. If you're on the right drug, you're likely to have good control of your seizures. But if you're on the wrong drug, you may keep having seizures -- and you might not even know that there are better approaches out there. That's why getting expert care can be important.

How Have Newer Drugs Changed Epilepsy Treatment?

We've had a lot of new drugs in the last 10 years or so: Felbatol, Neurontin (which is now the generic gabapentin), Lamictal, Topamax, Zonegran, Keppra, Trileptal, and Gabitril.

I think that all of these drugs have been shown to be effective in controlled trials. One of the nice things about these newer drugs is they tend to have fewer side effects. They're easier to use and more predictable. That's helpful, since we know that drug interactions are the bane of many patients.

When Should Someone With Epilepsy Consider Surgery?

Well, when medicines don't work, you think about epilepsy surgery. People used to think of surgery as a last resort, but that isn't the case anymore. Surgery can lead to long-term remission. It can be a true cure for epilepsy.

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