A seizure is caused by a sudden, uncontrolled burst of abnormal electrical activity in the brain. Effective treatment depends on the underlying cause, whether it's a one-time event or part of a chronic condition like epilepsy. A comprehensive approach involves immediate first aid, daily medication, and, in some cases, advanced interventions like surgery or neurostimulation.
Immediate care during a seizure
For someone witnessing a seizure, the primary goal is to ensure the person's safety and prevent injury.
Seizure First Aid (for tonic-clonic seizures)
- Stay Calm: Keep yourself and others calm to avoid causing further distress.
- Stay with the Person: Do not leave the person alone during or immediately after the seizure.
- Clear the Area: Move any nearby sharp or hard objects out of the way to prevent injury.
- Protect the Head: Place something soft and flat, like a folded jacket or blanket, under their head.
- Turn on Their Side: Gently roll the person onto one side to help keep their airway clear of saliva or vomit.
- Time the Seizure: Note the start time and end time. If a seizure lasts longer than 5 minutes, call for immediate medical help.
Actions to avoid
- Do NOT restrain the person. This can cause injury.
- Do NOT put anything in their mouth. A person having a seizure cannot swallow their tongue, and placing objects in their mouth can cause dental damage or other injuries.
- Do NOT offer food or drink until they are fully alert and aware of their surroundings.
Medication as a primary treatment
For most individuals with epilepsy, daily anti-seizure medications (ASMs), also called anticonvulsants, are the main line of defense. These medications cannot cure epilepsy but are effective at controlling seizures for about two-thirds of people.
Daily anti-seizure medications
There are over 20 different types of ASMs available, and finding the right one can take time. Your healthcare provider will consider factors like the type of seizures you experience, your age, lifestyle, and other health conditions. Common examples include:
- Levetiracetam (Keppra)
- Lamotrigine (Lamictal)
- Carbamazepine (Tegretol)
- Valproic acid (Depakene, Depakote)
- Topiramate (Topamax)
Side effects can occur with ASMs, but many are manageable and fade over time. It is crucial to take medication exactly as prescribed and to never stop abruptly without consulting a doctor, as this can trigger a dangerous seizure.
Rescue medications for emergencies
For individuals with a history of seizure clusters or prolonged seizures (status epilepticus), specific fast-acting rescue medications may be prescribed. These are typically benzodiazepines, which can be administered by a caregiver outside of a hospital setting.
- Diazepam: Available as a rectal gel (Diastat) or nasal spray (Valtoco).
- Midazolam: Available as a nasal spray (Nayzilam).
- Lorazepam: Often used in hospital settings and sometimes in an oral tablet form for home use.
Alternative and advanced treatment options
When daily medications are ineffective, known as refractory epilepsy, other treatment avenues are explored at specialized epilepsy centers.
Epilepsy surgery
Surgery may be an option for focal seizures that originate in a specific, well-defined area of the brain. The goal is to remove or destroy the brain tissue causing the seizures without damaging vital functions.
- Resection: Surgically removing the seizure focus.
- Thermal Ablation (LITT): Using a laser probe to destroy the targeted tissue with heat.
- Disconnection Procedures: Severing neural connections to prevent seizure spread.
Neurostimulation devices
These devices deliver electrical signals to the brain to disrupt abnormal activity and reduce seizure frequency.
- Vagus Nerve Stimulation (VNS): A device implanted in the chest sends electrical pulses to the brain via the vagus nerve in the neck.
- Responsive Neurostimulation (RNS): An implanted device monitors brain activity and delivers a precise electrical pulse when it detects a developing seizure.
- Deep Brain Stimulation (DBS): Electrodes are implanted deep within the brain and connected to a generator in the chest to provide regular electrical pulses.
Dietary therapies
Specialized diets can help manage seizures, particularly in pediatric cases or for those who do not respond to medication. These must be implemented under close medical supervision.
- Ketogenic Diet: A high-fat, low-carbohydrate, and controlled protein diet that alters metabolism and can reduce seizures.
- Modified Atkins Diet: A less restrictive version of the ketogenic diet.
Comparison of Seizure Treatment Options
| Treatment Type | Mechanism | Invasiveness | Typical Candidate | Seizure Freedom Potential |
|---|---|---|---|---|
| Daily Medication (ASMs) | Suppresses abnormal brain electrical activity. | Non-invasive (oral) | New diagnoses, generalized seizures. | Good (60-70% control rate) |
| Rescue Medication | Fast-acting benzodiazepines to quickly stop seizures. | Non-invasive (nasal, oral, rectal) | People with seizure clusters or emergencies. | High for stopping acute events |
| Dietary Therapy | Alters metabolism via high-fat, low-carb diet. | Non-invasive | Children with refractory epilepsy, or adults who fail medication. | Moderate |
| Neurostimulation Devices (VNS, RNS, DBS) | Delivers electrical pulses to modulate brain activity. | Minimally invasive (surgical implant) | Individuals with focal seizures not controlled by drugs. | Modest reduction in seizure frequency (often combined with meds) |
| Epilepsy Surgery | Removes or ablates the seizure-causing brain tissue. | Invasive | Focal seizures originating from a well-defined area. | High, sometimes leading to seizure freedom (75% for temporal lobe) |
The importance of lifestyle management
Alongside medical treatments, lifestyle modifications can significantly impact seizure control. Key factors include:
- Adequate Sleep: Lack of sleep is a common seizure trigger for many people.
- Stress Management: High stress levels can increase seizure frequency. Techniques like meditation or biofeedback may help.
- Trigger Avoidance: Identifying and avoiding personal triggers, which can include alcohol, flashing lights, or certain medications, is crucial.
- Medical ID: Wearing a medical alert bracelet or similar identification can provide critical information to first responders in an emergency.
Conclusion
There is no one-size-fits-all answer for what is the treatment for a seizure; rather, a personalized, multifaceted approach is key. For many, daily anti-seizure medications offer reliable control. For those with difficult-to-treat epilepsy, advanced options like neurostimulation, dietary therapy, or surgery offer new hope for reducing seizure frequency and improving quality of life. The process begins with proper diagnosis and involves continuous collaboration with a healthcare team to find the most effective combination of treatments. For people with persistent seizures despite two or more medication trials, a referral to a specialized epilepsy center is often recommended to explore advanced options.
Visit the Epilepsy Foundation website for more information on managing epilepsy and seizures.
