Epilepsy: Treatment and Diagnosis

Epilepsy is a common neurological disorder in which uncontrolled electrical activity in the brain causes recurrent seizures. If you receive an epilepsy diagnosis, your treatment plan will depend on the type of epilepsy you have and the kinds of seizures you experience.

Some epilepsy can be managed effectively by medication. In other cases, surgery may offer the best chance for seizure control. Some types of epilepsy may even resolve on their own over time.

As a Level 4 Epilepsy Center, certified by the National Association of Epilepsy Centers, Massachusetts General Hospital provides the highest level of epilepsy care available. Our team provides advanced neurodiagnostic monitoring, along with comprehensive medical, neuropsychological, and psychosocial treatment for even the most complex cases. We also offer full evaluations for epilepsy surgery, including intracranial monitoring and specialized surgical procedures that are not widely available at other institutions.

How Is Epilepsy Diagnosed?

Epilepsy is also known as "seizure disorder." The most important factor in diagnosing epilepsy is recurrent seizures. Your doctor will begin by reviewing your seizure symptoms, medical history, and any possible triggers to rule out other conditions that can cause seizures.

To confirm an epilepsy diagnosis, they may order other tests, such as electroencephalograph (EEG) or magnetic resonance imaging (MRI). Your doctor may also perform genetic testing since some epilepsy has a significant genetic component.

Learn about epilepsy symptoms and causes

Electroencephalogram (EEG)

An electroencephalogram, or EEG, is one of the main tools used to diagnose epilepsy. It uses electrodes attached to your scalp to measure electrical activity in the brain. Certain patterns of electrical activity indicate epilepsy and can help establish a diagnosis. EEGs are painless, noninvasive, and don't require anesthesia.

Eyewitness Accounts

Because many people don’t remember what happens during a seizure, your doctor may ask to speak with someone who has seen one of your episodes. A witness will be better able to describe what happened during the seizure—such as changes in movement, awareness, or behavior. A clearer picture of your seizure symptoms can help the doctor understand what type of seizure you had and the best way to manage your epilepsy.

Does epilepsy show up on an MRI?

An MRI won't show epilepsy directly, but it can help identify possible causes of seizures. Your doctor may order an MRI to look for structural changes in the brain, such as tumors, scarring, or signs of infection.

Your doctor may also order other kinds of imaging, such as PET, CT, or MEG scans. These tools can help pinpoint the area of the brain where seizures start.

Epilepsy Treatments

Epilepsy treatment focuses on controlling and reducing seizures. Most people begin with conservative approaches, such as medication, and may explore other epilepsy treatments like surgery only if conservative treatments are unsuccessful.

Medications for Epilepsy

There are many anti-seizure medications available. Your doctor will choose the right one for you based on:

• The type of seizure you're experiencing
• Your medical history
• Lifestyle considerations
• Pregnancy or plans to become pregnant
• Potential side effects or drug interactions

Brain Surgery for Epilepsy

If you've tried two or more medications and haven't been able to control your seizures, your care team may consider brain surgery for epilepsy.

Surgical approaches may include:

• Tissue removal: A procedure like resection or radiosurgery removes a small area of brain tissue where seizures start.
• Disconnection: These procedures interrupt the pathways that allow seizures to spread by cutting ties between parts of the brain where the seizures occur. In rare cases, the surgeon may sever the corpus callosum, the "bridge" that connects the two sides of your brain.
• Implantable devices: Devices like vagus nerve stimulators or deep brain stimulators can help regulate brain activity and reduce seizure frequency.

Surgical and implantable devices for treating epilepsy are typically considered for people with focal seizures, which start in one area of the brain. They may not be appropriate for people with generalized seizures, which affect both sides of the brain from the beginning.

Diet and Epilepsy Treatment

For some patients—especially children with drug-resistant epilepsy—a ketogenic diet may help reduce seizures.

Ketogenic diets are a high-fat, low-carbohydrate eating plan that causes your body to produce ketones, an alternate fuel source for your brain and body. In some people, a ketogenic diet can help control seizures.

If your doctor recommends a ketogenic diet, a dietitian will help you follow a precise and closely monitored plan, including portion sizes, fluid intake, and nutritional balance.

FAQs About Epilepsy Treatment and Diagnosis

Can epilepsy be cured?

There is no medical cure for epilepsy, but most epilepsy patients can manage it effectively. For some people, epilepsy goes away on its own.

Will epilepsy ever go away?

It depends. Each epilepsy diagnosis is unique. In some cases, epilepsy will go away on its own, while others live with epilepsy long term. Your doctor can give you the best sense of what to expect based on your diagnosis.

How can a neurologist tell if you have epilepsy?

A neurologist will evaluate your symptoms (such as frequency of seizures) and your medical history. They may also perform brain scans to look for abnormal brain activity associated with seizures.

What is the best way to manage epilepsy?

For most people, seizures can be controlled with medication. If medications don’t work, surgery or other therapies—like nerve stimulation or dietary changes—may be recommended to help reduce seizure frequency and improve quality of life.

Can epilepsy patients live a normal life?

Yes, many people with epilepsy lead full and active lives. With proper treatment, most can manage their symptoms well. Seizures are the primary symptom of epilepsy and vary widely, causing different effects depending on what part of the brain experiences the seizure.

How long does it take to diagnose epilepsy?

It depends. In general, your doctor won't diagnose epilepsy until you've had at least two unprovoked seizures more than 24 hours apart. In some cases, diagnosis may take longer, especially if doctors need to capture a seizure during EEG testing.

Are there any new treatments for epilepsy?

Medications and surgery do an excellent job of controlling epilepsy in most patients. However, scientists are continually exploring new ways to treat seizure disorders. Emerging epilepsy treatments include minimally invasive surgery and brain stimulation methods that don’t require an implant, such as magnetic stimulation.