What Is Epilepsy?
Epilepsy is a brain disorder that is marked by recurrent seizures. Seizures (also called fits or convulsions) are episodes of disturbed brain function caused by abnormalities of the brain’s electrical activity. There are many different types of seizures.
Epilepsy can affect people of all ages but is most common in young children and older adults. Some types of epilepsy are inherited and due to genetic factors. Other possible causes of epilepsy include brain injuries such as head trauma or oxygen deprivation at birth. In many cases, the cause of epilepsy is unknown (idiopathic).
A doctor will diagnose epilepsy based on a patient’s medical history, description of seizures, and various diagnostic tools. The most important diagnostic tool is the electroencephalogram (EEG), which allows doctors to record and analyze brain waves. Imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI) may also be used.
The goal of epilepsy treatment is to control seizures. Many different types of anticonvulsant drugs are available to treat epilepsy. Some patients need only one drug, while others may need to take several drugs. For patients who have not been helped by medication, surgery may be an option. Dietary changes, such as the ketogenic diet, have shown promise in helping some patients, especially children with severe epilepsy.
Anti-epileptic drugs (AEDs) can cause many side effects. Pregnant women with epilepsy need to take special precautions, because some of these drugs (particularly valproate) can cause birth defects.
In 2011, the FDA issued updated warnings on birth defect risks and AEDs:
In 2012, the FDA approved perampanel (Fycompa) as add-on treatment for partial seizures in patients ages 12 years and older. Perampanel is a new type of anti-epileptic drug that targets the AMPA glutamate receptor. It is taken once-daily as a pill at bedtime. In addition to typical AED side effects (dizziness, drowsiness), perampanel has a boxed warning to highlights risks of serious mood changes and mental disturbances, including violent thoughts and behaviors.
Epilepsy is a brain disorder involving repeated, spontaneous seizures of any type. There are different types of epilepsy but what they all share are recurrent seizures caused by an uncontrolled electrical discharge from nerve cells in the cerebral cortex. This part of the brain controls higher mental functions, general movement and sensation, the functions of the internal organs in the abdominal cavity, perception, and behavioral reactions.
Seizures are a symptom of epilepsy. Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in neuromuscular function, attention, or behavior. They are caused by abnormally excited electrical signals in the brain.
A single seizure may be related to a specific medical problem (such as brain tumor or withdrawal from alcohol). If repeated seizures do not recur after this underlying problem has been corrected, the person does not have epilepsy.
A single, first seizure that cannot be explained by a temporary medical problem has about a 25% chance of returning. After a second seizure occurs, there is about a 70% chance of future seizures and the diagnosis of epilepsy.
Epilepsy is generally classified into two main categories based on seizure type:
These seizures are subcategorized as "simple" or "complex partial."
In some cases, simple or complex partial seizures evolve into what are known as secondarily generalized seizures. The progression may be so rapid that the initial partial seizure is not even noticed.
Generalized seizures are caused by nerve cell disturbances that occur in more widespread areas of the brain than partial seizures. Therefore, they have a more serious effect on the patient. They are further subcategorized as tonic-clonic (or grand mal), absence (petit mal), myoclonic, or atonic seizures.
Tonic-Clonic (Grand Mal) Seizures. The first stage of a grand mal seizure is called the tonic phase, in which the muscles suddenly contract, causing the patient to fall and lie stiffly for about 10 - 30 seconds. Some people experience a premonition or aura before a grand mal seizure. Most, however, lose consciousness without warning. If the throat or larynx is affected, there may be a high-pitched musical sound (stridor) when the patient inhales. Spasms occur for about 30 seconds to 1 minute. Then the seizure enters the second phase, called the clonic phase. The muscles begin to alternate between relaxation and rigidity. After this phase, the patient may lose bowel or urinary control. The seizure usually lasts a total of 2 - 3 minutes, after which the patient remains unconscious for a while and then awakens to confusion and extreme fatigue. A severe throbbing headache similar to migraine may also follow the tonic-clonic phases.
Absence (Petit Mal) Seizures. Absence or petit mal seizures are brief losses of consciousness that occur for 3 - 30 seconds. Physical activity and loss of attention may pause for only a moment. Such seizures may pass unnoticed by others. Young children may simply appear to be staring or walking distractedly. Petit mal may be confused with simple or complex partial seizures, or even with attention deficit disorder. [For more information, see In-Depth Report #30: Attention deficit hyperactivity disorder.] In petit mal, however, a person may experience attacks as often as 50 - 100 times a day.
Myoclonic. Myoclonic seizures are a series of brief jerky contractions of specific muscle groups, such as the face or trunk.
Atonic (Akinetic) Seizures. A person who has an atonic (or akinetic) seizure loses muscle tone. Sometimes it may affect only one part of the body so that, for instance, the jaw slackens and the head drops. At other times, the whole body may lose muscle tone, and the person can suddenly fall. A brief atonic episode is known as a drop attack.
Simply Tonic or Clonic Seizures. Seizures can also be simply tonic or clonic. In tonic seizures, the muscles contract and consciousness is altered for about 10 seconds, but the seizures do not progress to the clonic or jerking phase. Clonic seizures, which are very rare, occur primarily in young children, who experience spasms of the muscles but not tonic rigidity.
Epilepsy is also grouped according to a set of common characteristics, including:
A few syndromes and inherited epilepsies are listed discussed below; they do not represent all epilepsies.
Temporal Lobe Epilepsy. Temporal lobe epilepsy is a form of partial (focal) epilepsy, although generalized tonic clonic seizures may occur with it.
Frontal Lobe Epilepsy. Frontal lobe epilepsy is characterized by sudden violent seizures. Seizures may also produce loss of muscle function, including the ability to talk. In autosomal dominant nocturnal frontal lobe epilepsy, a rare inherited form, seizures often occur during sleep.
West Syndrome (Infantile Spasms). West syndrome, also called infantile spasms, is a disorder that involves spasms and developmental delay in children within the first year, usually in infants ages 4 - 8 months.
Benign Familial Neonatal Convulsions. Benign familial neonatal convulsions (BFNC) are a rare, inherited form of generalized seizures that occur in infancy. BFNC appears to be caused by genetic defects that affect channels in nerve cells that carry potassium.
Juvenile Myoclonic Epilepsy (Impulsive Petit Mal). Juvenile myoclonic epilepsy, also called impulsive petit mal epilepsy, is characterized by generalized seizures, usually tonic-clonic marked by jerky movements (called myoclonic jerks), and sometimes absence seizures. It usually occurs in younger people ages 8 - 20.
Lennox-Gastaut Syndrome. Lennox-Gastaut syndrome is a severe form of epilepsy in young children that causes multiple seizures and some developmental disability. It usually involves absence, tonic, and partial seizures.
Myoclonic-Astatic Epilepsy. Myoclonic-astatic epilepsy (MAE) is a combination of myoclonic seizures and astasia (a decrease or loss of muscular coordination), often resulting in the inability to sit or stand without aid.
Progressive Myoclonic Epilepsy. Progressive myoclonic epilepsy is a rare inherited disorder typically occurring in children ages 6 - 15. It usually involves tonic-clonic seizures and marked sensitivity to light flashes.
Landau-Kleffner Syndrome. Landau-Kleffner syndrome is a rare epileptic condition that typically affects children ages 3 - 7. It results in the loss of ability to communicate either with speech or by writing (aphasia).
Status epilepticus (SE) is a serious, potentially life-threatening condition. It is a medical emergency. Permanent brain damage or death can result if the seizure is not treated effectively.
The condition is defined as recurrent convulsions that last for more than 30 minutes and are interrupted by only brief periods of partial relief. Although any type of seizure can be sustained or recurrent, the most serious form of status epilepticus is the generalized convulsive or tonic-clonic type. In some cases, status epilepticus occurs with the first seizure.
The trigger of status epilepticus is often unknown, but can include:
A seizure may be related to temporary conditions listed below. If the seizures do not recur after the underlying problem has been corrected, the person does not have epilepsy.
Conditions associated with nonepileptic seizures include:
Epileptic seizures are triggered by abnormalities in the brain that cause a group of nerve cells in the cerebral cortex (gray matter) to become activated simultaneously, emitting sudden and excessive bursts of electrical energy. A seizure's effect depends in part on the location in the brain where this electrical hyperactivity occurs. Effects range from brief moments of confusion to minor spasms to loss of consciousness. In most cases of epilepsy, the cause is unknown (also called idiopathic).
Ion Channels. Sodium, potassium, and calcium act as ions in the brain. They produce electric charges that must fire regularly in order for a steady current to pass from one nerve cell in the brain to another. If the ion channels that carry them are genetically damaged, a chemical imbalance occurs. This can cause nerve signals to misfire, leading to seizures. Abnormalities in the ion channels are believed to be responsible for absence and many other generalized seizures.
Neurotransmitters. Abnormalities may occur in neurotransmitters, the chemicals that act as messengers between nerve cells. Three neurotransmitters are of particular interest:
Some types of epilepsy are inherited conditions where genetics play a factor. Generalized epilepsy seizure types appear to be more related to genetic influences than partial seizure epilepsies.
Head Trauma. Head injuries to adults can cause epilepsy in both adults and children, with the risk highest in severe head trauma. A first seizure related to the injury can occur years later, but only very rarely. People with mild head injuries that involve loss of consciousness for fewer than 30 minutes have only a slight risk that lasts up to 5 years after the injury.
Oxygen Deprivation. Cerebral palsy, and other disorders caused by lack of oxygen to the brain during birth, can cause seizures in newborns and infants.
Epilepsy and seizure disorders affect nearly 3 million Americans and more than 45 million people worldwide.
Epilepsy affects all age groups. The risk is highest in children under the age of 2 and older adults over age 65. In infants and toddlers, prenatal factors and birth delivery problems are associated with epilepsy risk.
In children age 10 and younger, generalized seizures are more common. In older children, partial seizures are more common.
Males have a slightly higher risk than females of developing epilepsy.
People who have a family history of epilepsy are at increased risk of developing the condition.
Injuries from Falls. Because many people with seizures fall, injuries are common. Although such injuries are usually minor, people with epilepsy have a higher incidence of fractures than those without the disorder. Patients who take the drug phenytoin have an even higher risk, since the drug can cause osteoporosis.
Household Accidents. Household environments, such as the kitchen and bathroom, can be dangerous places for children with epilepsy. Parents should take precautions to prevent burning accidents from stoves and other heat sources. Children with epilepsy should never be left alone when bathing.
Driving and the Risk for Accidents. People with epilepsy who have seizures that are not controlled by medication are legally restricted from driving. In general, to obtain a driver's license, a doctor must confirm that a patient has been seizure-free for 3 - 6 months. Needless to say, seizures can be very dangerous if they occur while a person is driving and result in injuries to the patient or others.
Accidents while Swimming. Swimming poses another danger for people with epilepsy, particularly those with tonic seizures, which can cause the diaphragm to suddenly expel air. People with epilepsy who swim should avoid deep and cloudy water (a clear swimming pool is best), and always swim with a knowledgeable, competent, and experienced companion or have a lifeguard on site.
Long-Term General Effects. Long-term effects of seizures vary widely depending on the seizure's cause. The long-term outlook for children with idiopathic epilepsy (epilepsy of unknown causes) is very favorable.
Children whose epilepsy is a result of a specific condition (for example, a head injury or neurologic disorder) have lower survival rates, but this is most often due to the underlying condition, not the epilepsy itself.
Effect on Memory and Learning. The effects of seizures on memory and learning vary widely and depend on many factors. In general, the earlier a child has seizures and the more extensive the area of the brain affected, the poorer the outcome. Children with seizures that are not well-controlled are at higher risk for intellectual decline.
Social and Behavioral Consequences. Learning and language problems, and emotional and behavioral disorders, can occur in some children. Whether these problems are caused by the seizure disorder and anti-seizure medications or are simply part of the seizure disorder remains unclear.
Psychological Health. People with epilepsy have a higher risk for suicide, particularly in the first 6 months following diagnosis. The risk for suicide is highest among people who have epilepsy and an accompanying psychiatric condition, such as depression, anxiety disorder, schizophrenia, or chronic alcohol use. All antiepileptic drugs can increase the risk of suicidal thoughts and behavior. [For more information, see Medications section in this report.]
Overall Health. Patients with epilepsy often describe their overall health as "fair" or "poor," compared to those who do not have epilepsy. People with epilepsy also report more pain, depression, anxiety, and sleep problems. In fact, their overall health state is comparable to people with other chronic diseases, including arthritis, heart problems, diabetes, and cancer. Treatments can cause considerable physical effects, such as osteoporosis and weight changes.
Effects on Sexual Function. Some patients with epilepsy experience sexual dysfunction, including erectile dysfunction. These problems may be caused by emotional factors, medication, or a result of changes in hormone levels.
Effects on Reproductive Health. A woman’s hormonal fluctuation can affect the course of her seizures. Estrogen appears to increase seizure activity, and progesterone reduces it. Antiseizure medications may reduce the effectiveness of oral contraceptives.
Epilepsy can pose risks both to a pregnant woman and her fetus. Some types of anti-epileptic drugs should not be taken during the first trimester because they can cause birth defects. Women with epilepsy who are thinking of becoming pregnant should talk to their doctors in advance to plan changes in their medication regimen. Women should learn about the risks associated with epilepsy and pregnancy, and precautions that can be taken to reduce them. [For more information, see “Treatment during Pregnancy” in Treatment section of this report.]
Patients whose epilepsy is well controlled generally have a normal lifespan. However, long-term survival rates are lower than average if medications or surgery fail to stop the seizures. The lower survival rate is partly due to a higher-than-average risk for death due to accidents and suicide. The specific cause of the seizure may also contribute to fatalities.
Although relatively rare, there is a risk for sudden unexpected death in patients with epilepsy, a syndrome abbreviated as SUDEP. Although the causes of such events are not fully known, heart arrhythmias and pauses in breathing (apnea) may be factors in many cases. Your doctor can explain if you have specific risk factors for SUDEP and what protective measures can be taken.
The best preventive measure is to take your medication as prescribed. Talk with your doctor if you have any concerns about medication side effects or dosages. Do not make any changes to your drug regimen without speaking first with your doctor.
An epilepsy diagnosis is often made during an emergency visit for a seizure. If a person seeks medical help for a previous or suspected seizure, the doctor will ask about the patient's medical history, including seizure events.
Electroencephalogram (EEG). The most important diagnostic tool for epilepsy is an EEG, which records and measures brain waves, which reflect the electrical activity of nerve cells in the brain. Ideally, it should be performed within 24 hours of a seizure. An EEG recording session may last for less than an hour, but in some cases the doctor will want a day-long recording or a recording during sleep. Long-term monitoring may be necessary when patients do not respond to medications. Portable EEG units are available in some places, which can be used to monitor patients throughout normal activities. EEGs are not foolproof. Repeated EEGs are often needed to confirm a diagnosis, particularly for certain partial seizures that often produce an initially normal EEG reading.
Video Electroencephalography (Video EEG). For this test, patients are admitted to a special part of the hospital where they are monitored both by EEG and are also watched by a video camera. Patients may need to undergo video EEG monitoring for a variety of reasons including withdrawal or addition of medications in a patient with difficult-to treat-epilepsy, before epilepsy surgery for some patients, and also when nonepileptic seizures are suspected.
Computerized Tomography (CT) Scans. A CT scan is usually the initial brain imaging test ordered for most adults and children with first-time seizures. This imaging technique is sensitive enough for most purposes. In children, even if the scan is normal, the doctor will follow up to be sure other problems are not present.
Magnetic Resonance Imaging (MRI). Doctors strongly recommend MRIs for children with first seizures who are younger than age 1 year or who have seizures that are associated with any unexplained significant mental or motor problems. MRI scans may help to determine if the disorder can be treated with surgery, and may be used as a guide for surgeons.
Other Advanced Imaging Techniques. Some research centers use other types of imaging techniques. Positron emission tomography (PET) may help locate damaged or scarred locations in the brain where partial seizures are triggered. These findings may help determine which patients with severe epilepsy are good candidates for surgery. Single-photon emission computer tomography (SPECT) may also be used to decide if the surgery should be performed and what part of the brain needs to be removed. Both of these imaging techniques are generally only needed when an MRI of the brain has not been helpful.
Conditions that may cause symptoms similar to epilepsy include:
You cannot stop a seizure, but you can help the patient prevent serious injury.
Remain calm, and do not panic, then take the following actions:
Do not leave the patient alone. Someone nearby should call 911. Patients should be taken to an emergency room when:
Not all patients with chronic epilepsy need to go to the hospital after a seizure. Hospitalization may not be necessary for patients whose seizures are not severe or repetitive, and who have no risk factors for complications. All patients or caregivers, however, should contact their doctors after a seizure occurs.
Treatment with anti-epileptic drugs (AEDs) is usually initiated or strongly considered for the following patients:
There is some debate about whether to treat every adult patient with an AED after a single initial seizure. Some doctors do not recommend treating adult patients after a single seizure if they have a normal neurologic examination, EEG, and imaging studies.
Epileptic seizures can often be controlled using a single-drug regimen. First-line AED drugs include phenytoin (Dilantin, generic), carbamazepine (Tegretol, generic), and divalproex sodium (Depakote, generic). Patients generally begin with low doses and build up to higher doses until the seizures are controlled or a toxic reaction occurs. If a single drug fails to control seizures, other drugs are added on. The specific drugs and whether more than one should be used are determined by various factors, including the patient's age and the seizure type, frequency, and cause.
During the first few months of therapy, the doctor will probably order blood tests once or twice to monitor drug levels and, if necessary, adjust dosages. Monitoring is used to check for AED complications, and to be sure the patient is complying with the regimen. These blood tests may be, however, a less reliable indicator of problems than patients’ own observations of response to the drug. For instance, blood tests may suggest that the dosage levels are insufficient according to general standards, yet the individual patient may be seizure-free and leading a normal life.
Anti-epileptic drugs interact with many other drugs, and may cause special problems in older patients who use multiple medications for other health problems. Elderly patients should have liver and kidney function tests performed before starting antiseizure medication. It is also very important that women have AED levels monitored during pregnancy (see "Treatment During Pregnancy" below).
Most patients who have responded well to medications can stop taking AEDs within 5 - 10 years. Evidence suggests that medications in children should not be halted for at least 2 years after the last seizure, particularly if they have partial seizures and abnormal EEGs. It is not clear whether children who have been free of generalized seizures need to wait more than 2 years or if they can withdraw earlier.
Preparing to Become Pregnant. Women with epilepsy who are considering pregnancy should talk to their doctors before they become pregnant. According to guidelines from the American Academy of Neurology and the American Epilepsy Society:
Medication Use During Pregnancy. Women should discuss with their doctors the risks of anti-epileptic drugs (AEDs) and the possibility of making any changes in their drug regimen in terms of dosages or prescriptions. According to current guidelines:
Breastfeeding. If women on AEDs breastfeed they should be aware that some types of AEDs are more likely than others to pass into the breast milk. The following AEDs appear to be the most likely to pass into breast milk in clinically important amounts: Primidone, levetiracetam, and possibly gabapentin, lamotrigine, and topiramate. Valproate does pass into breast milk, but it is unclear if it affects the nursing infant. A mother should watch for signs of lethargy or extreme sleepiness in her infant, which could be caused by her medication. Talk with your doctor about any concerns you have about breastfeeding and AEDs.
Anti-epileptic drugs (AEDs) include many types of medications but all act as anticonvulsants. Many newer AEDs are better tolerated than the older, standard AEDs, although they can still have troublesome side effects. Newer AEDs often cause less sedation and require less monitoring than older drugs. Although newer AEDs are generally FDA-approved for use as add-ons to standard drugs that have failed to control seizures, they are often prescribed as single drugs. Specific choices usually depend on the patient’s particular condition and the specific side effects of the AED.
All antiepileptic drugs can increase the risks of suicidal thoughts and behavior (suicidality). Research has shown that the highest risk of suicide can occur as soon as 1 week after beginning drug treatment and can continue for at least 24 weeks. Patients who take these drugs should be monitored for signs of depression, changes in behavior, or suicidality.
Valproate sodium (Depacon, generic), valproic acid (Depakene, generic), and divalproex sodium (Depakote, generic) are anticonvulsants that are chemically very similar to each other. (In this report, they are referred to together as valproate.) Valproate products are the most widely prescribed anti-epileptic drugs worldwide. They are the first choice for patients with generalized seizures and are used to prevent nearly all other major seizures as well.
Side Effects. These drugs have a number of side effects that vary depending on dosage and duration. Most side effects occur early in therapy and then subside. The most common side effects are upset stomach and weight gain. Less common side effects include dizziness, hair thinning and loss, and difficulty concentrating.
Serious side effects include:
Carbamazepine (Tegretol, Equetro, Carbatrol, generic) is used for many types of epilepsy. It is taken alone or in combination with other drugs. In addition to controlling seizures, it may help relieve depression and improve alertness. A chewable form is available for children.
Side Effects. Different side effects may develop or resolve at different points during treatment. Initial side effects may include:
Serious side effects are less common but can include:
Note: Grapefruit, Seville oranges, and tangelos can increase carbamazepine's blood levels and risk of adverse effects.
Phenytoin (Dilantin, generic) is effective for adults who have the following seizures or conditions:
This drug is not useful for the following seizures:
Side Effects. Side effects are sometimes difficult to control. Some people may develop a toxic response to normal doses, while others may require higher doses to achieve benefits. As with any drug, side effects generally depend on dosage and duration. Side effects may include:
Phenobarbital (Luminal, generic), also called phenobaritone, is a barbiturate anticonvulsant. Primidone (Mysoline, generic) is converted in the body to phenobarbital, and has the same benefits and adverse effects.
Barbiturates may be used to prevent grand mal (tonic-clonic) seizures or partial seizures. They are no longer typically used as first-line drugs, although they may be the initial drug prescribed for newborns and young children.
Side Effects. Phenobarbital has fewer toxic effects on other parts of the body than most anti-epileptic drugs, and drug dependence is rare, given the low doses used for treating epilepsy. Nevertheless, many patients experience difficulty with side effects.
Patients sometimes describe their state as "zombie-like." The most common and troublesome side effects are:
When taken during pregnancy, phenobarbital, like phenytoin and valproate, may lead to impaired cognitive function in the child. There has been some evidence that phenobarbitol may cause heart problems in the fetus.
Ethosuximide (Zarontin, generic) is used for petit mal (absence) seizures in children and adults when the patient has experienced no other type of seizures. Methsuximide (Celontin), a drug similar to ethosuximide, may be suitable as an add-on treatment for intractable epilepsy in children.
Side Effects. This drug can cause stomach problems, dizziness, loss of coordination, and lethargy. In rare cases, it may cause severe and even fatal blood abnormalities. Periodic blood counts are recommended for patients taking this drug.
Clonazepam (Klonopin, generic) is recommended for myoclonic and atonic seizures that cannot be controlled by other drugs and for Lennox-Gastaut epilepsy syndrome. Although clonazepam can prevent generalized or partial seizures, patients generally develop tolerance to the drug, which causes seizures to recur.
Side Effects. People who have had liver disease or acute angle glaucoma should not take clonazepam, and people with lung problems should use the drug with caution. Clonazepam can be addictive, and abrupt withdrawal may trigger status epilepticus. Side effects include drowsiness, imbalance and staggering, irritability, aggression, hyperactivity in children, weight gain, eye muscle problems, slurred speech, tremors, skin problems, and stomach problems.
Lamotrigine (Lamictal, generic) is approved as add-on (adjunctive) therapy for partial seizures, and generalized seizures associated with Lennox-Gastaut syndrome, in children aged 2 years and older and in adults. Lamotrigine is also approved as add-on therapy for treatment of primary generalized tonic-clonic (PGTC) seizures, also known as “grand mal” seizures, in children aged 2 years and older and adults. Lamotrigine can be used as a single drug treatment (monotherapy) for adults with partial seizures. Birth control pills lower blood levels of lamotrigine.
Side Effects. Common side effects include dizziness, headache, blurred or double vision, lack of coordination, sleepiness, nausea, vomiting, insomnia, and rash. Although most cases of rash are mild, in rare cases the rash can become very severe. The risk of rash increases if the drug is started at too high a dose or if the patient is also taking valproate. (Serious rash is more common in young children who take the drug than it is in adults.) Rash is most likely to develop within the first 8 weeks of treatment. Be sure to immediately notify your doctor if you develop a rash, even if it is mild.
Lamotrigine may cause aseptic meningitis. Symptoms of meningitis may include headache, fever, stiff neck, nausea, vomiting, rash, and sensitivity to light. Patients who take lamotrigine should immediately contact their doctors if they experience any of these symptoms.
Gabapentin (Neurontin, generic) is an add-on drug for controlling complex partial seizures and generalized partial seizures in both adults and children.
Side Effects. Side effects include sleepiness, headache, fatigue, and dizziness. Some weight gain may occur. Children may experience hyperactivity or aggressive behavior. Long-term adverse effects are still unknown.
Pregabalin (Lyrica) is similar to gabapentin.It is approved as add-on therapy to treat partial-onset seizures in adults with epilepsy.
Side Effects. Dizziness, sleepiness, dry mouth, swelling in hands and feet, blurred vision, weight gain, and trouble concentrating may occur.
Topiramate (Topamax, generic) is similar to phenytoin and carbamazepine and is used to treat a wide variety of seizures in adults and children. It is approved as add-on therapy for patients 2 years and older with generalized tonic-clonic seizures, partial-onset seizures, or seizures associated with Lennox-Gastaut syndrome. It is also approved as single drug therapy.
Side Effects. Most side effects are mild to moderate and can be reduced or prevented by beginning at low doses and increasing dosage gradually. Common side effects may include numbness and tingling, fatigue, abnormalities of taste , difficulty concentrating, and weight loss. Serious side effects may include glaucoma and other eye problems. Tell your doctor right away if you have blurred vision or eye pain. If used during pregnancy, topiramate can increase the risk for cleft lip or palate birth defects.
Oxcarbazepine (Trileptal, generic) is similar to phenytoin and carbamazepine but generally has fewer side effects. It is approved as single or add-on therapy for partial seizures in adults and for children ages 4 years and older.
Side Effects. Serious side effects, while rare, include Stevens-Johnson syndrome and toxic epidermal necrolysis. These skin reactions cause a severe rash that can be life threatening. Rash and fever may also be a sign of multi-organ hypersensitivity, another serious side effect associated with this drug. Oxcarbazepine can reduce sodium levels (hyponatremia). Your doctor may want to monitor the sodium (salt) level in your blood. This drug can reduce the effectiveness of birth control pills. Women who take oxcarbazepine may need to use a different type of contraceptive.
Zonisamide (Zonegran, generic) is approved as add-on therapy for adults with partial seizures.
Side Effects. Zonisamide increases the risk for kidney stones. It may reduce sweating and cause a sudden rise in body temperature, especially in hot weather. Other side effects tend to decrease over time and may include dizziness, forgetfulness, headache, weight loss, and nausea.
Levetiracetam (Keppra, generic) is approved both in oral and intravenous forms as add-on therapy for treating many types of seizures in both children and adults.
Side Effects. These tend to occur mostly in the first month. They include sleepiness, dizziness, and fatigue. More serious side effects may include muscle weakness and coordination difficulties, behavioral changes, and increased risk of infections.
Tiagabine (Gabitril) has properties similar to phenytoin and carbamazepine.
Side Effects. Tiagabine may cause significant side effects including dizziness, fatigue, agitation, and tremor. The FDA has warned that tiagabine may cause seizures in patients without epilepsy. Tiagabine is only approved for use with other anti-epilepsy medicines to treat partial seizures in adults and children 12 years and older
Ezogabine (Potiga), a potassium channel opener, was approved in 2011 for treatment of partial seizures in adults. Ezogabine is used as an add-on (adjunctive) medication. Its most serious side effect is urinary retention. Patients should be monitored for symptoms such as difficulty initiating urination, weak urine stream, or painful urination. Other side effects may include coordination problems, memory problems, fatigue, dizziness, and double vision.
Perampanel (Fycompa) was approved in 2012 as add-on treatment for partial onset seizures in patients age 12 years and older. Perampael is the first in a new class of AEDs for uncontrolled partial epilepsy. It targets the AMPA glutamate receptor, which is involved in seizure activity. Perampanel is taken as a once-daily tablet. Common side effects may include dizziness, drowsiness, and fatigue. Peramanel also has a boxed warning to alert about potential risks of serious mood changes and mental disturbances including irritability, aggression, anxiety, and violent thoughts or behaviors.
Felbamate. Felbamate (Felbatol) is an effective antiseizure drug. However, due to reports of deaths from liver failure and from a serious blood condition known as aplastic anemia, felbamate is recommended only under certain circumstances. They include severe epilepsy, such as Lennox-Gastaut syndrome, or as monotherapy for partial seizures in adults when other drugs fail.
Vigabatrin. Vigabatrin (Sabril) has serious side effects, such as vision disturbances, and is generally prescribed only in specific cases. It is sometimes given in low doses for patients with Lennox-Gastaut syndrome. Vigabatrin is also prescribed as a low-dose oral solution to treat infantile spasms in children ages 1 month to 2 years.
Surgical techniques to remove injured brain tissue may be appropriate for some patients with epilepsy. The surgeon's goal is to remove only the damaged tissue to prevent seizures and to avoid removing healthy brain tissue. The goal is to eliminate or at least reduce seizure activity while not causing any functional deficits, such as deterioration of speech or cognitive abilities.
Surgical techniques and pre-surgical planning for reaching these goals have improved significantly over the past decades due to advances in imaging and monitoring, new surgical techniques, and a better understanding of the brain and epilepsy.
A number of tests using imaging and electroencephalography (EEG) can determine if surgery is an option: