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Understanding Seizures -- Diagnosis and Treatment

How Do I Know If I Have Seizures?

To diagnose an apparent first-time seizure, your doctor will:

  • Take a detailed medical history (including a family history of seizures)
  • Gather information about your behavior before, during, and after the episode
  • Do a physical exam

These are tests that may be done:

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  • An electroencephalogram (EEG) to identify any abnormal electrical misfiring in the brain and help predict the risk of future seizures
  • Brain imaging tests such as an MRI or CT scan to help narrow down a possible treatable cause
  • A spinal tap if an infectious cause, such as meningitis, is suspected

 

What Are the Treatments for Seizures?

When a specific cause of the seizure is identified -- such as infection or low blood sugar -- treatment of that underlying condition often prevents seizures from recurring. If the underlying cause is not fully treatable or is unknown, treatment with antiseizure medications may be recommended.

Medications for Epilepsy

Anticonvulsant drugs can eliminate or reduce recurrent seizures. The choice of medication is based on the specific seizure type and pattern. Often, a single drug is used, but sometimes a combination may be necessary. Anticonvulsant drugs include:

  • Eslicarbazepine acetate (Aptiom)
  • Carbamazepine (Tegretol)
  • Divalproex sodium (Depakote)
  • Fycompa (Perampanel)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Levetiracetam (Keppra)
  • Oxcarbazepine (Trileptal)
  • Oxteller XR (oxcarbazepine)
  • Phenobarbital
  • Phenytoin (Dilantin)
  • Pregabalin (Lyrica)
  • Primidone (Mysoline)
  • Tiagabine (Gabitril)
  • Topiramate (Topamax)
  • Valproic acid (Depakene)
  • Vigabatrin (Sabril)
  • Zonisamide (Zonegran) 

For some drugs, your doctor may test your blood to make sure you are taking the right amount of medication. Blood tests can also make sure drugs are not affecting your kidneys or liver. Some people may be able to stop taking medication once their seizures have been under control for at least a year.

Surgery and Other Procedures for Seizures

Doctors may suggest surgery for the few patients whose seizures can't be controlled with medications. In vagus nerve stimulation, a device that electronically stimulates the vagus nerve (which controls activity between the brain and major internal organs) is implanted under the skin. This reduces seizure activity in some patients with partial seizures. 

There’s also the responsive neurostimulation device (RNS), which consists of a small neurostimulator implanted within the skull under the scalp. The neurostimulator is connected to one or two wires (called electrodes) that are placed where the seizures are suspected to originate within the brain or on the surface of the brain. The device detects abnormal electrical activity in the area and delivers electrical stimulation to normalize brain activity before seizure symptoms begin.

Surgery may be recommended for the minority of patients whose seizures can't be controlled with medications. The most successful procedures are those in which the diseased area of the brain is identified and can be removed. There are other surgeries that involve disconnecting pathways between parts of the brain to prevent the seizure from spreading.

Diet and Lifestyle

Stress may increase seizure activity in certain individuals. Relaxation techniques, biofeedback, and yoga may be helpful when used with medications. A diet known as the ketogenic diet is used with some kids -- but only under strict supervision. This diet has helped some children with seizures, but it can be very dangerous.

WebMD Medical Reference

Reviewed by Richard Senelick, MD on April 03, 2013

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