Treatment of seizures

• NICE and SIGN Guidelines
• Why we treat seizures
• Anti-epileptic drugs (AEDs)
• Drug level monitoring
• Vagus nerve stimulation (VNS)
• Ketogenic diet

NICE and SIGN Guidelines

The National Institute for Health and Clinical Excellence (NICE) is an organisation which provides guidance on treatments and care for people using the NHS in England, Wales and Northern Ireland. In Scotland the Scottish Intercollegiate Guidelines Network (SIGN) performs a similar role.

The NICE Guidelines (2004) and SIGN Guidelines (2003) on the treatment of epilepsy, state that people with learning disabilities should have the same access to treatment for their epilepsy as anybody else. They may also have additional treatment needs, which should be met by appropriate health professionals.

The NICE and SIGN Guidelines recommend that people with epilepsy should have their epilepsy and treatment reviewed every year.

Why we treat seizures

Anti-epileptic drugs (AEDs) are given to reduce or stop seizures.

This is because a person who has uncontrolled seizures may be injured and need hospital treatment or even die early. They may not be able to drive or work in certain jobs. All decisions on treatment are designed to improve the person’s quality of life. 

Anti-epileptic drugs (AEDs)

The main way of treating epilepsy is with anti-epileptic drugs  (AEDs). It’s important that these are taken every day, as prescribed by the doctor.

Doctors generally prefer monotherapy (using one AED at a time). When one AED doesn’t work, polytherapy (more than one drug) is usually the next step. Because AEDs don’t all work in the same way, it may be that two different AEDs together could improve seizure control. Many doctors would rather not give more than two drugs at a time.

Drug level monitoring

It can be useful in some circumstances, such as when people are having seizures or side-effects from their anti-epileptic drugs (AEDs), to measure blood levels. This is done by taking a blood sample.

Blood levels show the amount of a drug in the body. If blood levels of AEDs are too high, they can cause unpleasant side-effects. If the blood levels are too low, the drug might not control seizures.

Drugs can produce very different blood level readings in different people, even if they take exactly the same amount of drugs. This is because it takes some people longer than others to break down the AEDs in their bodies and get rid of each dose.

Drug levels can only be used as a general guide. And some AEDs are not suitable for measuring in this way. So, a doctor or nurse shouldn’t usually change the dosage of AEDs on the basis of drug levels alone. The AED phenytoin is an exception to this. The doctor or nurse should also take into account how the person feels, and any problems they are having.

It’s also important they look out for symptoms such as drowsiness or unsteadiness, which could be a sign the person is taking too many AEDs. If you are caring for someone, you could keep a record of any of these signs or symptoms, to show the doctor or nurse. You might want to keep a special seizure/side-effect diary for this purpose.

Vagus nerve stimulation (VNS)

Vagus nerve stimulation (VNS) is a treatment for epilepsy where a small device (similar to a heart pacemaker) is put under the skin in the chest. This is attached to a lead which is connected to the vagus nerve in the side of the neck. Stimulating the vagus nerve can mean someone could have fewer, less severe seizures. The VNS seems to work well for some people, but not for others.

• More information about vagus nerve stimulation

Ketogenic diet

The ketogenic diet is a diet that is high in fats and low in carbohydrates. It’s sometimes used to treat children with difficult to control epilepsy. Although some children find the diet unpleasant and difficult to follow, other children manage it very well. The ketogenic diet should only be used under the supervision of a doctor and a dietician specialising in the ketogenic diet.

Currently, there are no centres offering the ketogenic diet for adults in the UK. This might change in the future, when more research has been done.

• More information about the treatment of epilepsy