There are many things a provider and person with epilepsy can do to stop or lessen seizures.

The most common treatments for epilepsy are:

•  Seizure medication also called Anti-seizure drugs or anti-epileptic drugs are medicines that limit the spread of electrical activity in the brain. The neurologist will change the seizure medicine dose or prescribe a new drug if needed for the best treatment of epilepsy. Seizure Medicines work for about 2 in 3 patients with epilepsy (60-70%).
• Surgery.  When electrical activity due to seizures come from a single particular area of brain (focal seizures), brain surgery may be done to remove that area to stop future seizures. Epilepsy surgery is commonly done if the seizure focus is located in the temporal lobe of the brain and the person is not responding to 2 or more seizure medication

4. Other treatments. When seizure medication fails and epilepsy surgery is not possible or not feasible, treatments modalities such as vagus nerve stimulation or ketogenic diet can be considered

The common seizure medications include phenytoin, valproate, phenobarbitone, levetiracetam, brivacetam, carbamazepine and oxcarbamazepine

Add on medications for seizures include clobazam, topiramate, zonisamide, perempanel, lamotrigine, ethosuximide, lacosamide

In special situations, steroids, vigabatrin, nitrazepam and clonazepam are also used

There is nothing like best seizure medicine. The choice of seizure medicine is dependent on age of patient, work profile, type of seizures, type of epilepsy and cause of epilepsy

The success rate or effectiveness of seizure medication is roughly 60-70%. Meaning that out of 100 patients with epilepsy, 60-70% will not have seizure recurrence, and 30-40% might still have recurrence on seizure medication

No medicines are 100% effective. The goal of seizure treatment is to prevent serious seizures, reduce the seizure duration, reduce the frequency of seizures and minimise emergency visits to hospital. So yes, do not stop seizure medication, even if there are seizure recurrences in spite of medications.

During any illness like cough cold and loose stools, do not stop the seizure medication, else there would be seizure recurrence. Some antibiotics can cause drug interaction with seizure medication. So, please discuss with your local physician about the medicines. Do not take over the counter medication especially antibiotics. The risk of seizure recurrence is maximum during fever, and Viral illness.

The epilepsy medicines are safe. No seizure medications have no side effects. All medications have low risk of side-effects, but they are not severe or not life threatening. Pls discuss the side effects with the doctor. Your neurologist doctor will explain you the specific follow up for each medication

Epilepsy medicines might cause sedation or excessive sleepiness. But this is transient, and reduces with time. Reduced intelligence is uncommon, but can be due to effects of recurrent seizure. The question you should ask yourself is that what is dangerous: seizures or side effect of medicines. What is it that you want to prevent: seizures or side effect of medicines? Every treatment has some effects. That doesn’t mean that you do not take the treatment. The only thing is that you must understand the side effect of seizure treatment

In general, for a person with single episode of seizure, seizure medications are not started if both EEG and MRI brain is normal

If either of them is abnormal or the first seizure is prolonged duration (> 5 min), its recommended to start seizure medicines

The simple answer is yes. But if gap between 2 seizures is more than 2 years, you may wait. In such a condition, you have to understand the risk involved. Seizures are usually not dangerous or life threatening. But injuries during seizures can be life threatening. The goal of seizure treatment is to prevent serious seizures, reduce the seizure duration, reduce the frequency of seizures and minimise emergency visits to hospital. Prolong seizures > 5min and multiple seizure in one day, usually necessitates hospital admission for few days. Regular seizure medication may reduce this risk. If you do not start seizure medication, you will always live-in worry about seizure recurrence and will affect work quality and performance

Roughly, seizure medication is given for 2-3 years from the time of last seizures. However, the duration of treatment is different for different types of epilepsy. Certain epilepsy like juvenile myoclonic epilepsy needs lifelong treatment. Almost 80% of benign Childhood onset epilepsies will stop having seizures by 12-14 years of age

First epilepsy treatment is not a course like antibiotics. The epilepsy medicines are medicines for control of seizures and they actually do not cure the epilepsy. Epilepsy gets cured when the electrical focus of seizures in brain stops firing excessive abnormal currents. It is expected that the seizure focus will improve in 2-3 years

The cure rate of epilepsy is dependent on type of epilepsy and cause of epilepsy. Hypocalcaemia seizures are 100% treatable. Fever with seizure may not recur and are cured in 2-4 years. Seizures with neurocysticercosis have a very variable course. Absence epilepsy treatment is roughly till 10-14 years of age.

There is recurrence rate of 10-15% of seizure if seizure medicines are stopped. The recurrence risk is dependent on number of seizure medicines, number of seizures, degree of EEG abnormality at diagnosis, MRI abnormality, degree of EEG abnormality at stopping medicines, family history of epilepsy.

The recurrence risk is maximum in first 6 months, but the seizures can recur can recur later as well. Patients will abnormal MRI have life-long risk of seizures. The recurrence risk is dependent on type of epilepsy.

I developed seizure recurrence after stopping medicines, how long is the further course?

If you develop seizure recurrence after stopping medicines, it means the seizure focus is still active. You will have to take the seizure medicines

If you develop a seizure on missing dose, it means that the seizure focus in your brain is active and you need to continue seizure medications. The duration of treatment, is minimum 2-3 years from the last seizure

One must know that epilepsy medicines are not addicting. If you develop a seizure on stopping medicines, it means that the seizure electrical focus in brain is still active. Seizure medication should not be stopped abruptly, but tapered as per supervision of neurologist. In certain types of epilepsies, treatment may be lifelong

Many kinds of doctors treat patients with epilepsy. These doctors include general physicians, paediatricians, neurologist, epileptologist. Seizures are also managed by neurosurgeons due to surgical causes. These doctors may start initial treatment and may discuss with a neurologist.

A neurologist is a doctor who specializes in the brain disorders, spine and nerves. An epileptologist is a neurologist who specializes in epilepsy. When seizures recur or treatment fails, it is best to take treatment by a neurologist or epileptologists for best and expert epilepsy treatment.

Patients with difficult to control seizures or poorly controlled epilepsy or seizures inspire of multiple seizure medications may be referred to an epilepsy centre. Epilepsy centres are available in Delhi, Pune, Mumbai, Chennai, Bangalore, Trivandrum, Kochi. The centres are managed by staff who specialize in epilepsy care, such as

• Epileptologists and neurologists.
• Epilepsy Nurses.
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• EEG Technicians.
• Neurosurgeons
• Epilepsy Radiologist
• Nuclear Physicians

There are several ways you can find a neurologist or an epileptologist near you. Your general physician can guide you about types of specialists.

Self-management is what you do (or your nearby friends and relatives) to take care of yourself during emergency. You (nearby friends and relatives) should know how to manage seizures. Begin with these simple tips:

• Take your medicine.
• Talk with your doctor or nurse when you have questions.
• Recognize seizure triggers (such as flashing or bright lights).
• Keep a record of your seizures.
• Keep a record of medicines you are taking along with doses
• Get enough sleep.
• Lower stress.

To prevent seizures, you may be able to figure out the trigger that caused seizure recurrence. Identification of trigger is the easiest treatment of epilepsy. To know more, read here