First, finding the right medication depends on what type of epilepsy you have, partial seizures (also called focal seizures) or generalized seizures. All medications don’t work on all types of seizures, and the wrong medication potentially can make seizures worse.

The Food and Drug Administration has approved more than 30 anti-seizure medications, and each has its own advantages and disadvantages.

For example, some anti-seizure medications also can help with migraine or depression, while others may make depression worse. They can cause weight gain or weight loss, require periodic blood tests or may be more likely to interact poorly with another medication you are taking.

“Because anti-epilepsy drugs need to be taken for life, it’s important to find a drug that does the most to eliminate seizures with the fewest possible side effects,” said Lauren P. Mosier, DNP, APRN, with Norton Neuroscience Institute.

Common side effects are fatigue, an upset stomach, dizziness and blurred vision. Many drugs also have rarer, serious side effects such as liver failure, drug reaction rash, or causing suicidal thoughts and behavior.

Anti-seizure medications also can cause issues with attention, memory and concentration.

It’s important to remember side effects vary from person to person. Just because a drug has a potential side effect does not mean you will experience it.

An epilepsy specialist can help you find a medication tailored for your individual needs. The specialist also can help with dosing, especially if you are just starting on an anti-seizure medication.

Starting at a low dose and gradually increasing the dosage often causes many of the side effects to go away over several weeks or months. Even so, the vast majority of people on an epilepsy medication will still experience at least one side effect.

Ideally, a single drug can control your seizures and leave you with tolerable side effects. For 6 in 10 people, the initial anti-seizure medication makes them seizure free.

It’s generally recommended if one anti-epilepsy drug doesn’t work, then a second should be tried individually, when possible — picking a medication that works differently on the brain and body.

You may find your anti-seizure medication works well initially, but the effectiveness wears off over time. With the end of this so-called honeymoon effect, you may need a higher dose, which could in turn worsen the side effects.

An epilepsy specialist can help you weigh the pros and cons of continuing with one medication versus trying another.

Taking a single drug is called monotherapy. Taking two or more anti-seizure drugs is called polytherapy. If your provider recommends polytherapy, it is important that you follow up regularly for monitoring.

If you fail on two or more anti-seizure medications, you can try polytherapy or surgery to combat your seizures. 

Norton Neuroscience Institute Comprehensive Epilepsy Center is nationally recognized as a level 4 center by the National Association of Epilepsy Centers, meaning patients receive the highest level of medical and surgical evaluation and treatment.

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Syncope — commonly referred to as passing out or fainting — often results from a drop in blood pressure.

Seizures, on the other hand, are caused by abnormal brain activity. The reason behind the abnormal activity may be epilepsy, stroke, cancer or an infection in the brain.

People who pass out as a result of syncope generally recover on their own, and there may be no lasting symptoms. Seizures tend to last longer and often are followed by confusion and extreme fatigue.

“If you lose consciousness, you should talk to your health care provider. Both seizures and syncope can have serious causes and should be checked out,” said Ambica M. Tumkur, M.D., neurologist, Norton Neuroscience Institute.

The difference between syncope and seizure often can be detected by looking at brain waves using an electroencephalogram (EEG). What happened just before the loss of consciousness also can offer clues about the cause.

To function properly, your brain needs blood pumping from the heart as well as controlled electrical signals. When a seizure or syncope occurs, one of these processes is not working the way it should.

About half of syncope cases are caused by a drop in blood pressure. Fainting like this can be caused by stress, such as exposure to injury or blood, fatigue, standing for too long, or being in a hot or crowded place. The loss of consciousness often is preceded by lightheadedness, nausea, feeling warm or cold, sweating, weakness, dizziness, blurred vision or changes in hearing. Syncope also can have more serious causes. These include an irregular heartbeat or issues with blood flow to the brain. 

You should call 911 if the person is not breathing, does not wake up after one minute, has difficulty moving or speaking after waking up, has chest pains or heart palpitations, is injured or fainted while exercising or lying down.

Unlike syncope, seizures happen not from a drop in blood pressure, but because of uncontrolled activity in the brain. The underlying cause can be epilepsy, infection, brain injury, fever, stroke, withdrawal from some drugs, electrolyte imbalances, low blood sugar or sleep deprivation.

Seizures do not always result in a loss of consciousness. They may cause someone to make a noise or cry out when the seizure begins, to bite their tongue or suddenly urinate. Some people report a strange feeling just before the seizure begins, which is sometimes referred to as an “aura.” Seizures can cause convulsions, which usually begins with muscles stiffening and then enters a phase of uncontrolled rhythmic movement. Someone who has a seizure usually has no memory of the experience.

With epilepsy, seizures happen more than once and occur spontaneously, without any apparent cause.

If you see someone having a seizure, get them to the floor if they are not already lying down.  Move hard or sharp objects away from them. Do not try to restrain them and don’t put anything in the person’s mouth.

You should call 911 if it is a person’s first seizure, if the seizure lasts for more than five minutes, seizures happen one after another, the person appears to be choking or having difficulty breathing, the person is injured or the seizure happens in water.

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“It’s important to let your health care provider know right away if you have any mood changes on Keppra,” said Rebekah J. Woods, D.O., neurologist, Norton Neuroscience Institute.

Some epilepsy patients taking Keppra experience “seething rage, uncontrollable anger, fits of fury and violence.”

In addition to aggression, Keppra can cause depression and suicidal tendencies. One study found that one in every 530 Keppra users reported suicidal thoughts.

Overall, serious side effects with Keppra are unlikely. These side effects appear to occur more frequently in people who have had prior issues related to mood or mental health, including psychosis.

Other, less serious behavioral side effects with Keppra include irritability, agitation, aggression, anxiety, apathy, hostility and nervousness. One or more of these side effects were experienced by 13% of adult patients taking Keppra and 38% of children taking the drug.

Because seizure medications act on the brain, everyone responds to them a little bit differently. It is impossible to predict which side effects you will experience on a particular anti-seizure drug.

Side effects tend to be worse if the dosage is increased too fast or if there is too much of the drug circulating in your blood, according to the Epilepsy Foundation. Because of this, doctors generally prescribe a lower dose and increase the dosage as needed.

If you do experience Keppra rage, your health care provider may lower your dose or take you off the drug gradually in order to try another drug. It’s important not to suddenly stop taking Keppra, as your seizures may become worse. Approximately one in 60 adults taking Keppra stop because of the side effects.

Keppra is not the only anti-seizure drug associated with behavioral side effects. Behavioral side effects are common in anti-seizure medications because they are making chemical changes in the same parts of your brain responsible for mood and emotion.

According to the Epilepsy Foundation, Sabril, Gabitril, Zonegran, phenobarbital and Mysoline can also increase symptoms of depression. Neurontin and Zonegran can also increase irritability, and Felbatol can also increase anxiety.

Keppra is approved by the FDA to control seizure in adults, children and infants one month or older. It works by stabilizing abnormal electrical activity in the brain.

Keppra is used to treat epilepsy and seizure disorders, including:

• Adult and juvenile myoclonic epilepsy
• Temporal lobe epilepsy
• Focal impaired awareness or complex partial seizures
• Myoclonic Seizures
• Secondarily generalized seizures or bilateral tonic-clonic seizures
• Focal aware onset seizures
• Tonic-clonic seizures

Keppra is not recommended for people who have had depression, or are pregnant or planning to be pregnant.

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Birth control and epilepsy

Hormones play a key role in when someone might have a seizure.

Oral contraceptives (often referred to as “the pill”), some intrauterine devices (IUDs), implants and injections deliver specific amounts of specific hormones to prevent pregnancy. Epilepsy drugs sometimes can interfere with hormonal birth control, making the birth control less effective at preventing unplanned pregnancy.  

Dr. Woods asks all her patients with epilepsy to plan their pregnancies and talk to their health care team.

“I have patients take folic acid before and during pregnancy to prevent birth defects. I also want to know if they are trying to conceive and if they get pregnant and it was not planned,” Dr. Woods said.

It is important to tell your health care providers if you are planning to get pregnant. It is also critical not to stop taking epilepsy medications.

“I monitor patients carefully,” Dr. Woods said. “We can tweak medications and find what works for the patient and potentially the baby.”

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In order to determine the best treatment plan for managing epilepsy, it is important to understand the impact that psychosocial factors have on your life and how that interacts with an epilepsy diagnosis.

The impact of epilepsy

Epilepsy can affect your physical mobility, memory and even your ability to work or drive, so treatment is crucial. In addition to these physical effects, the emotional impact of epilepsy on a patient should not be understated.

“We look at the whole person to figure out their psychosocial history and assess appropriate interventions,” said Caitlin Zoeller, LCSW, social worker with Norton Neuroscience Institute Resource Centers. “That means taking a detailed inventory of someone’s emotional, mental and physical health to get a complete picture.”

Epilepsy and medications to treat it may impair concentration, affect energy levels, or lead to anxiety or depression that ultimately affect a patient’s quality of life. A psychosocial assessment helps providers ensure that an intervention plan treats the whole patient. They may recommend medication, surgical treatment, support groups, physical therapy or driving assessments to support the patient’s journey.

Education is key

It is important to have patience with yourself and others as you process your diagnosis and condition. In addition to understanding your psychosocial history, it also can be important to educate friends, family and co-workers about the condition.

“People see things on TV or in movies about people with epilepsy,” Caitlin said. “Epilepsy symptoms vary widely. People might make assumptions about your condition that don’t necessarily apply to you.”

The first step is to educate the people around you about your epilepsy and to be honest about your limitations.

“You want to make sure they understand how epilepsy may impact your life, like not being able to drive after a seizure or missing work,” Caitlin said.

You also can invite people to educate themselves.

“Norton Neuroscience Institute Resource Centers have an abundance of resources for patients to use and share with others,” Caitlin said. “The most important piece of advice I can share is that you don’t have to go it alone if you have epilepsy. Don’t be afraid to ask for help.”

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Should I have surgery for epilepsy?

“Medication-resistant epilepsy” (known medically as refractory epilepsy) is a condition where seizures do not stop with medicine. Uncontrolled seizures can result in health risks, including physical harm — think drowning — during a seizure; sudden unexpected death in epilepsy (SUDEP); depression and anxiety; or worsening memory and thinking skills.

Your doctors will run tests to see if you are a candidate for epilepsy surgery. Tests include electroencephalogram (EEG), MRI, and brain-mapping tests like functional MRI and a Wada test. Epilepsy neurologists with Norton Neuroscience Institute (Ambica M. Tumkur, M.D.; Rebekah J. Woods, D.O.) then collaborate with epilepsy neurosurgeons (Abigail J. Rao, M.D.; David A. Sun, M.D., Ph.D.). 

“We find surgery is highly effective if the seizures originate in one place in the brain,” Dr. Rao said.

Types of surgery for epilepsy

Norton Neuroscience Institute neurosurgeons use ROSA, a robotic-assisted surgery tool, to map the safest route through the brain to identify the source of epilepsy disorders. The ROSA system generates a 3D map of your brain, so surgeons can see structures at any angle and any depth. With the imaging in hand, surgeons use ROSA’s robotic arm to thread tiny tools through holes the width of spaghetti noodles, to the source of your seizures. This surgery, through small incisions, avoids removing part of the skull.

Other epilepsy surgeries include:

• Resective surgery: The surgeon removes the portion of the brain where seizures originate. This can be the site of a tumor, brain injury or malformation.
• Laser interstitial thermal therapy (LITT): Using a laser to focus on and destroy a small portion of brain tissue, this surgery uses a minimal incision while MRI heat maps guide the laser the surgeon uses.
• Deep brain stimulation: A small device is inserted permanently into the brain to deliver electrical signals that disrupt seizure-inducing impulses.
• Responsive neurostimulation: A closed-loop device implant that monitors and responds to brain waves.

“Our multidisciplinary team considers which option is best for the individual patient, allowing us to offer excellent surgical outcomes and leading-edge care,” Dr. Sun said.

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The following year, Katie began having seizures. Dr. Puri diagnosed her with epilepsy, unrelated to POTS. While he was able to control her seizures with medication, she wasn’t completely seizure-free.

“It was difficult being diagnosed with two medical conditions, especially at that age,” Katie said.

Throughout college and her early 20s, Katie had such faith in Dr. Puri that she continued her care in Louisville and “graduated” to seeing the adult providers at Norton Neuroscience Institute. In 2012, she had a vagus nerve stimulator (VNS) implanted by David A. Sun, M.D., Ph.D., neurosurgeon. This device sends pulses of electrical energy through the vagus nerve to the brain to help prevent seizures.

People with epilepsy are prone to migraine, and Katie was no different. Before her epilepsy surgery, Katie had been experiencing migraine attacks that eventually put a stop to her world.

“I was living with more headache days than not a month,” Katie said. “I found myself having to take life day by day again.”

‘Bring her home. I know someone who can help’

By the time her headaches were so frequent, Katie had moved out of state. Making the drive to Louisville for care while a migraine attack could strike at any moment wasn’t realistic. She sought help from a neurologist near her.

“The neurologist said that because of my other medical issues, there was nothing he could do and relegated me to an emergency room pain protocol,” she said. “I wanted a treatment plan and a solution, not painkillers.”

During one particularly terrible migraine attack, Katie’s parents called Dr. Puri from the hospital in desperation.

“He told my parents, ‘You need to bring her home. I know someone who can help,’” Katie said.

Dr. Puri referred her to Brian M. Plato, D.O., headache neurologist with Norton Neuroscience Institute. At her first appointment, Dr. Plato offered her a solution-oriented approach to migraine management and a treatment plan that didn’t include narcotics.

“Dr. Plato gave me hope that I wasn’t sentenced to a life with debilitating migraine attacks,” Katie said.

Married and back in Louisville, Katie gets team-based care; her ‘health has never been better’

Dr. Plato also worked closely with Katie’s other Norton Neuroscience Institute neurologists to ensure he was up to date on Katie’s overall health.

“Katie’s journey is the perfect example of our team approach at Norton Neuroscience Institute, where patients can see the specialist best suited for each phase of their care,” Dr. Plato said. “I can focus on the most up-to-date migraine treatment options for Katie, knowing that another trusted team member is simultaneously providing the most up-to-date care for her epilepsy. Each of us works together with the singular goal of making our patients’ lives better.”

Fortunately in better health, Katie and her husband, Ross Deppe, M.D., moved to Atlanta, Georgia, where he completed his residency and fellowship training. Katie never considered establishing care with a neurologist in her new city. Instead, she made a trip to see Dr. Plato every three months because, to her, the trust she had in him was worth it.

Today, the trip is much more convenient. When she and Ross were deciding where he would practice medicine after his training, the place that gave Katie her life back felt like the right fit to start their next chapter. He now is a physician with Norton Gastroenterology Consultants of Louisville.

But that’s not the end of Katie’s full circle of care. She now is a patient of Norton Neuroscience Institute epileptologist Ambica M. Tumkur, M.D., and is happy to report that she has not had a seizure since getting the VNS.

“My health has never been better,” Katie said. “Dr. Plato and all of my Norton doctors understood that quality of life is just as important as treatment. They worked to find that balance and gave me my life back. I am forever grateful.”

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According to the Centers for Disease Control (CDC), about 3.4 million Americans have active epilepsy. Epilepsy, or seizure disorder, is diagnosed after a patient has two or more seizures with no other obvious cause (such as a head injury or high fever). While seizures can be triggered by head injuries, infections or reactions to alcohol or a drug, having a seizure does not necessarily mean you have epilepsy. It’s important to visit a doctor to be evaluated.

How do I know if I had a seizure?

Seizures don’t always look the way television and movies show them: a person violently shaking, etc. Although some seizures a person to collapse, have muscle spasms in many parts of the body, and lose consciousness, there are more subtle seizures as well. Sometimes, a person might blink rapidly or stare into space. Other seizures may become confused or dazed and don’t respond or answer questions for a few minutes.

What causes seizures?

Epilepsy can be caused by other conditions that affect the brain such as stroke, brain tumors or head injuries. Many times, the cause is not known. You should always see a doctor as soon as possible after your first seizure.

How are seizures treated?

It depends on what kind of seizures you have, their frequency and whether the cause is known. There are some medicines a doctor might give you. You can also manage epilepsy by:

• Getting enough sleep
• Exercising and maintaining a healthy weight
• Eating a well-balanced diet
• Lowering stress
• Avoiding your known triggers

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Epilepsy is an umbrella term for a group of seizure disorders. A brain condition, epilepsy is sometimes the result of a brain injury or a family predisposition, but often there is no known cause.

Is it safe for someone with epilepsy to get pregnant?

Most women with epilepsy have normal, healthy babies. However, there are several factors that may make it more difficult to conceive including:

• Women with epilepsy have higher rates of some conditions that can cause infertility including polycystic ovary syndrome (PCOS).
• Women with epilepsy are more likely to have irregular menstrual cycles or cycles where no egg is released (anovulation), which can make it more difficult to get pregnant.
• Anti-seizure medicine and other drugs may affect the hormone levels in your ovaries, which can affect reproductive functioning.
• Women with epilepsy are more likely to have abnormalities in hormones involved in pregnancy.

What are some things I can do when trying to get pregnant?

Talk with your doctor about the medications you are taking for your epilepsy. Some drugs used to treat seizures may contribute to infertility, but some may reduce the effectiveness of hormonal birth control methods such as the pill. Take care of your general health with a balanced diet and exercise, as directed by your doctor.

What are the risks?

Any medication taken during pregnancy can affect the baby. Anti-seizure medication has been linked to birth defects, including cleft palate, neural tube defects, skeletal abnormality and congenital heart defects. Some studies suggest that the risk increases with higher doses of medication or when taking multiple anti-seizure medications.

Seizures during pregnancy can result in:

• Slowing of fetal heart rate
• Decreased oxygen to the fetus
• Fetal injury, including separation of the placenta from the uterus, or miscarriage from trauma (such as a fall during a seizure)
• Preterm labor
• Premature birth

Talk to your doctor about changing medications if you wish to become pregnant. Try to do it at least a year in advance so you have time to let your body adjust and see if the new medicine works well for you.

Epilepsy during labor and delivery

The most important thing is to work closely with your doctor and care team before and during pregnancy so you can minimize potential risks to your health and the health of your baby.

During labor and delivery, you may be afraid of having a seizure. While it is a possibility, the doctor will be aware of your condition and can give you IV anti-seizure medication. Or you may have a planned cesarean section (C-section).

The risks of pregnancy with epilepsy may sound overwhelming, but remember that the vast majority of women with epilepsy have uneventful pregnancies and normal, healthy babies. It is important to know the risks, follow your doctors’ guidelines and take care of yourself.

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Stigma can lead some individuals with epilepsy to be uncomfortable spending significant time in public. Anxiety can come from not knowing if strangers know how to help during a seizure.

Going to school, work or even the grocery store can become difficult when there is uncertainty of how others might respond to a seizure.

Challenges of Living With Epilepsy

• Anticipating and addressing seizure triggers such as lack of sleep or medication, stress, alcohol, flashing lights and sometimes even certain types of music are made even more difficult by the unique triggers that affect individual patients.
• Getting from place to place can be difficult. In Kentucky, epilepsy patients must be seizure-free for 90 days to become eligible for a driver’s license. Lack of transportation options combined with physical limitations can result in reduced career options for those with epilepsy.
• Like many neurological disorders, epilepsy can cause irritability, forgetfulness, anxiety, difficulty paying attention, fatigue and depression. Medication that can control epilepsy can lead to some of the same side effects.

Help Is Available for Living With Epilepsy

Classes are available with a focus on education and support. These sessions offer medical, behavioral and peer perspectives.

“Shared experience can be overlooked. Having a platform to get feedback from professionals and people going through the same thing as you can be very empowering. This creates a sense of community between patients,” said Christopher Hurley, certified social worker with Norton Neuroscience Institute Resource Center.

New patients especially appreciate the chance to learn from others who have lived with epilepsy for years. Their ability to thrive in the face of adversity is a source of inspiration and assurance for those recently diagnosed.

Medical professionals attend these classes to provide information on topics such as medication and side effects or diet and lifestyle recommendations. They also take questions to from patients.

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