Epilepsy treatment: what actually works and what to try first

One in 26 people will have epilepsy at some point. That sounds alarming, but treatment options are wide and practical. If you or someone you care about has seizures, this page lays out the main treatments, what they do, and everyday steps to reduce seizures and stay safe.

Medications: the first line

Most people start with anti-seizure medicines (also called antiepileptic drugs or AEDs). Common ones are levetiracetam (Keppra), lamotrigine (Lamictal), carbamazepine (Tegretol), valproate (Depakote), topiramate (Topamax), and others. Your neurologist will pick a drug based on the seizure type, age, sex, other conditions, and possible side effects.

Expect a trial-and-error process. One medicine may stop seizures; sometimes you need a second drug or a combination. Watch for side effects like dizziness, sleepiness, mood changes, weight change, or rash. Some drugs need blood tests (valproate, carbamazepine) and others affect hormonal birth control—ask your doctor if you’re planning pregnancy or using contraceptives.

Practical tip: use a pillbox and phone alarms. Missing doses is a top trigger for breakthrough seizures.

Surgery, devices, and diets

If medicines don’t control seizures, other options can help. Resective surgery removes the small brain area causing seizures—it works best for a single, well-defined focus, like many temporal lobe cases. Other surgical approaches include hemispherectomy (rare) or corpus callosotomy for specific patterns of severe seizures.

Less invasive devices: vagus nerve stimulation (VNS) sends mild pulses to reduce seizure frequency. Responsive neurostimulation (RNS) detects abnormal activity and gives targeted stimulation. Both can lower seizures when drugs alone fail.

The ketogenic diet—very low carb, high fat—can cut seizures in some children and adults. Modified versions exist that are easier to follow. Work with a dietitian and neurologist if you try it.

Ask about clinical trials if standard options aren’t enough. New meds and technologies appear regularly.

First aid matters: when a seizure happens, protect the head, remove dangerous objects, time the event, and roll the person onto their side if possible. Don’t put anything in the mouth or try to restrain them. Call emergency services if the seizure lasts more than 5 minutes, if breathing is slow after, or if injury occurs.

Everyday management: track seizures in a notebook or app, get plenty of sleep, avoid heavy alcohol use, and plan medication refills early. Talk with your employer or school about reasonable accommodations if seizures are frequent.

Finally, always work with a neurologist or epileptologist for diagnosis and treatment changes. If you’re pregnant or planning pregnancy, ask specifically about medicines—some raise birth defect risks and need careful planning. With the right approach, many people with epilepsy lead full, active lives.