Seizure treatment isn’t one-size-fits-all. If you or someone you care about has seizures, the goal is controlling seizures with the fewest side effects. Doctors pick drugs based on the seizure type, age, other health issues, pregnancy plans, and drug interactions. Here’s a practical look at common options and what to expect.
Levetiracetam (Keppra): A go-to for many because it works for several seizure types and has few drug interactions. Many people tolerate it well, but irritability, mood changes, or sleepiness can happen.
Valproate (Depakote): Very effective for generalized seizures and certain epilepsy syndromes. Avoid in pregnancy if possible—it raises the risk of birth defects. Other effects include weight gain, tremor, and the need for liver checks.
Carbamazepine (Tegretol): Often used for focal (partial) seizures. It works well but interacts with lots of other meds and may need blood level monitoring. It can also make some generalized seizure types worse, so proper diagnosis matters.
Lamotrigine (Lamictal): Good for focal and generalized seizures and tends to have fewer cognitive side effects. The main worry is a serious rash early on, so doctors increase the dose slowly.
Topiramate (Topamax): Helps with seizures and migraine prevention. Downsides: word-finding trouble, slower thinking for some, and a risk of kidney stones. It can help people who want to lose weight but isn’t right for everyone.
Older drugs like phenytoin and phenobarbital still work but have more long-term side effects and interactions. Benzodiazepines (diazepam, lorazepam) are lifesavers for stopping prolonged seizures but aren’t for daily use due to tolerance and sleepiness.
If medications don’t fully control seizures, there are other choices. The ketogenic diet can cut seizures for some, especially kids. Vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) are implantable devices that reduce seizures for many people. For focal epilepsy that comes from a single brain area, surgery can be curative. Cannabidiol (prescription CBD) helps specific syndromes like Dravet and Lennox-Gastaut.
Practical tips: always report new side effects, take medicines exactly as prescribed, and don’t stop suddenly. If you’re planning pregnancy, talk to your neurologist—some drugs need switching or special monitoring. Keep a seizure diary, list all medicines and supplements, and wear medical ID if seizures are frequent.
Want to change meds or try a device? Ask about expected benefits, side effects, monitoring needs, and how long to wait before judging effectiveness. Your neurologist can help map a clear plan so you can focus on life, not seizures.
