Treatment

Not everyone who has one seizure will have another one. Because a seizure can be an isolated incident, your doctor may not decide to start treatment until you've had more than one.

The optimal goal in seizure treatment is to find the best possible therapy to stop seizures, with the fewest side effects.

Medications

Many medications are available to treat temporal lobe seizures. However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common.

Discuss possible side effects with your doctor when deciding about treatment options. Also ask what effect your seizure medications and other medications you take, such as oral contraceptives, may have on each other.

Surgical or other procedures

When anti-seizure medications aren't effective, other treatments may be an option:

• Surgery. The goal of surgery is to stop seizures from happening. This is often done through a traditional surgery, where surgeons operate to remove the area of the brain where seizures begin. In certain people, surgeons may be able to use MRI-guided laser therapy as a less invasive way to destroy the area of damaged tissue that causes seizures.

  Surgery works best for people who have seizures that always originate in the same place in their brains. Surgery generally isn't an option if your seizures come from more than one area of the brain, your seizure focus can't be identified or your seizures come from a region of the brain that performs vital functions.

• Vagus nerve stimulation. A device implanted underneath the skin of your chest stimulates the vagus nerve in your neck, sending signals to your brain that inhibit seizures. With vagus nerve stimulation, you may still need to take medication, but you may be able to lower the dose.
• Responsive neurostimulation. During responsive neurostimulation, a device implanted on the surface of your brain or within brain tissue can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure.
• Dietary therapy. Following a diet that's high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, may be less effective. However, they aren't as restrictive as the ketogenic diet and might provide some benefit.

Pregnancy and seizures

Women who've had previous seizures typically are able to have healthy pregnancies. Birth defects related to certain medications can sometimes occur.

In particular, valproic acid (Depakene) — one possible medication for generalized seizures — has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby.

Discuss these risks with your doctor. Because of the risk of birth defects, and because pregnancy can alter medication levels, preconception planning is particularly important for women who've had seizures.

In some cases, it may be appropriate to change the dose of seizure medication before or during pregnancy. Medications may be switched in rare cases.

Contraception and anti-seizure medications

It's also important to know that some anti-seizure medications can alter the effectiveness of oral contraceptives — a form of birth control — and some oral contraceptives can speed up the absorption of seizure medications. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.