Effective strategies for managing epilepsy

April 29, 2024

Providence Health Team

[5 min read]

Types of epilepsy

There are two main types of epilepsy: focal and generalized. A focal seizure starts somewhere in one hemisphere of the brain where the wiring has been damaged, and so the symptoms the person experiences are related to that part of the brain. A generalized seizure, on the other hand, involves both hemispheres of the brain. It can have a physical component, such as jerking or muscle spasms, or no physical component, which is also called an absence seizure.

Debunking common myths

Felicia Ferguson, M.D., a neurologist at Providence Neurological Specialties – West in Portland, Oregon, says she has come across several myths about epilepsy in her practice.

Myth 1: A person who has seizures does something to provoke the seizure.

Dr. Ferguson: I always tell people the No. 1 reason for the seizure is no good reason. It’s just a very sporadic, unpredictable disease. We can’t identify a specific cause with the testing we have right now.

Myth 2: All types of epilepsy are the same.

Dr. Ferguson: Though there are two main types of epilepsy, there are many, many differences within those broader categories. Some people experience dozens of seizures a day, while others may only have a few in their lifetime.

Myth 3: You can prevent epilepsy.

Dr. Ferguson: While you can certainly aim to live a healthy life, most people who have epilepsy do so for reasons beyond their control.

Identifying and managing seizure triggers

Common triggers for epileptic seizures

Of course, every person with epilepsy is different, and seizures often occur at seemingly random times. But some people find that their seizures tend to occur in certain situations. Common triggers include:

Sleep deprivation
Flashing bright lights
Illness
Alcohol
Drug use
Stress
Menstrual cycle
Use of certain medications, or missed medications

Personal trigger identification and management

If you have epilepsy, the best way to identify your triggers is by keeping a seizure diary. When you have a seizure, note the day and time of day, how long the seizure was, and any unusual activities or circumstances that were happening that day.

You can share the information from your seizure diary with your doctor, who can help you notice patterns and adjust treatment accordingly.

Treatment options for epilepsy

Medications: Types and considerations

The gold-standard epilepsy treatment is medication — although there are many different types that can cause many different side effects.

“There have been anti-seizure medications around since the 1840s,” says Dr. Ferguson. “Newer medications are not more effective than the older ones. However, people respond to different medications in unique ways. Your doctor’s goal is to find a medication that works right for you.”

Surgical options and when to consider them

About 30% of people who have epilepsy aren’t able to control their seizures with medication, says Dr. Ferguson. For those people, epilepsy surgery might be an option — but only if they have focal epilepsy. “The chance of success with surgery is higher if they have a lesion that we can see in imaging tests,” she says.

Other options for treatment include vagus nerve stimulation, deep brain stimulators and responsive nerve stimulation.

Diet and nutrition

Some health care providers recommend that their patients adopt a ketogenic diet to decrease the frequency of their seizures. A ketogenic diet is a special high-fat, low-carbohydrate diet that is prescribed by a doctor and monitored by a dietitian to control seizures.

Dr. Ferguson has only recommended such a diet for a small number of her patients who experience very frequent seizures. “We have to weigh the health risks of having frequent seizures and the patient’s quality of life against the health risks of the diet,” she says. “If the seizures are very bad, it might be the best option.”

Finding community and support groups

If you’re interested in finding a support group in your area, Dr. Ferguson suggests that you visit the Epilepsy Foundation’s website, which lists local advisory boards, support groups and opportunities to become an epilepsy advocate.

“It can be really hard to find a good epilepsy support group, because epilepsy is such a broad diagnosis,” she says. “If you’re looking for support, don’t be discouraged if it takes a little longer than you were expecting.”

How Providence can help

The Providence Epilepsy Center, which is located in Portland, Oregon, is one of the nation’s top centers for epilepsy diagnosis and treatment. It provides a full range of services for both children and adults who have epilepsy, including evaluation for surgery.

If you or your child are having difficulties managing your epilepsy and want to talk to an expert or get a second opinion, come see one of the epileptologists at Providence.

Contributing caregiver

Felicia Ferguson, M.D., is a neurologist at Providence Neurological Specialties – West in Portland, Oregon.

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