Epilepsy treatment: what works and what to try first

If you or someone you care about has epilepsy, the questions are practical: which medicine, when to see a specialist, and how to stay safe day to day. Treatment aims to stop seizures or reduce their frequency and side effects. Most people get good control, but it often takes time to find the right plan.

Common treatment options

First-line care is usually antiepileptic drugs (AEDs). Doctors pick a drug based on the seizure type, age, other health issues and possible side effects. Common choices include levetiracetam, carbamazepine, lamotrigine, and valproate. Each works differently and has different risks—valproate, for example, can cause birth defects and is avoided in pregnancy when possible. Stick to the prescribed dose, and never stop suddenly without medical advice; that can trigger more seizures.

If medicines don’t control seizures, other options exist. Epilepsy surgery can remove or disconnect the brain area that starts seizures—great results are possible for the right patients. Vagus nerve stimulation (VNS) and responsive neurostimulation are implantable devices that reduce seizures over time. The ketogenic diet (high fat, low carb) helps some children and adults, often under medical supervision. Your neurologist or epilepsy specialist will explain which option fits your situation.

Practical tips for daily management

Keep a seizure diary: note date, time, triggers, duration, and recovery. That helps your doctor tweak treatment. Sleep and stress matter—aim for regular sleep and stress-reducing habits because sleep loss and strong stress can trigger seizures. Avoiding heavy alcohol and recreational drugs lowers risk too.

Safety matters. If a friend has a seizure, stay calm: keep them safe from sharp objects, cushion their head, turn them on their side after shaking stops so they can breathe, and time the seizure. Do not put anything in their mouth. Call emergency services if the seizure lasts more than 5 minutes, if another starts right after, or if they’re injured or pregnant.

Talk about driving, work and pregnancy with your doctor. Many places require seizure-free periods before driving again. Women of childbearing age should discuss AEDs and contraception—some drugs reduce contraceptive effectiveness and some raise pregnancy risks. If pregnancy is planned or possible, work with your neurologist to find the safest treatment plan.

Regular follow-ups are key. Blood tests may be needed for some drugs, and side effects should be reported early—mood changes, balance issues, or unusual rashes need attention. If seizures change in pattern or get worse, seek care promptly. Epilepsy treatment is rarely one-size-fits-all, but with the right team and steady care, many people live full, active lives.