Several effective treatments exist for seizures, and the right approach depends on the type of seizures, their frequency, and their cause. Medication is the first line of defense, and roughly 46% of people become seizure-free with the very first drug they try. For those who need more, options range from dietary changes and nerve stimulation devices to surgery. Knowing what to do during a seizure and how to reduce triggers also makes a real difference in daily life.
Medication: The First Step for Most People
Anti-seizure medications work by calming overactive electrical signals in the brain. Some do this by stabilizing the channels that let charged particles flow in and out of nerve cells. Others boost the brain’s natural braking system (a chemical messenger called GABA) or dial down excitatory signals that can spark a seizure. A neurologist chooses a specific medication based on the seizure type, your age, other health conditions, and potential side effects.
The success rates are encouraging. In a large observational study, 45.7% of patients achieved complete seizure freedom on their first medication. When a second medication was tried in those who didn’t respond, the combined total rose to nearly 90% of all patients who eventually stayed seizure-free for at least a year. That means for most people, the right pill is out there. It sometimes just takes an adjustment.
If two or more appropriately chosen medications fail to control seizures, the condition is considered drug-resistant. About one in three people with epilepsy falls into this category, and that’s when doctors explore additional or alternative treatments.
The Ketogenic Diet
A high-fat, very low-carbohydrate diet called the ketogenic diet has been used to treat seizures since the 1920s, and it remains one of the most effective non-drug options, especially for children with hard-to-treat epilepsy. When carbohydrates are severely restricted, the body burns fat for fuel and produces molecules called ketone bodies. These ketone bodies appear to calm seizure activity through several pathways: they boost GABA (the brain’s main inhibitory signal), reduce glutamate (the main excitatory signal), and lower oxidative stress in brain cells.
Clinical studies consistently show that more than 50% of children on the diet experience at least a 50% reduction in seizure frequency, a threshold considered clinically meaningful. In one study of 41 children with drug-resistant epilepsy, about 11% saw their seizures drop by 90%, and roughly 5% became completely seizure-free. The diet requires strict medical supervision and careful meal planning, so it’s typically managed by a specialized dietitian alongside a neurologist.
Vagus Nerve Stimulation
For people whose seizures don’t respond well to medication, a small device implanted under the skin of the chest can help. Vagus nerve stimulation (VNS) sends mild electrical pulses through a nerve in the neck to the brain, reducing seizure activity over time. It doesn’t replace medication but works alongside it.
VNS tends to improve gradually. In a multicenter study, about 33% of patients responded within the first year, with 7% becoming seizure-free. By three years, the response rate climbed to 51%, and nearly 16% were seizure-free. Among patients who kept the device for more than five years, 55% responded. The most common side effects are hoarseness, coughing, and tingling sensations, but these are usually temporary and can be managed by adjusting the device’s settings.
Surgery
When seizures consistently originate from one identifiable area of the brain and medications haven’t worked, surgery can be highly effective. The most common procedure involves removing the small region of brain tissue responsible for triggering seizures. Temporal lobe epilepsy, the most common form in adults, is particularly well suited to surgical treatment.
Candidacy for surgery requires meeting three key criteria: the patient agrees to the possibility of a surgical approach, seizures remain disabling despite adequate trials of at least two medications, and imaging and electrical brain recordings point to a specific, surgically treatable source. A thorough pre-surgical evaluation, including brain scans and monitoring, helps the surgical team map exactly where seizures start and whether removing that tissue can be done safely.
CBD for Specific Childhood Epilepsies
A purified form of cannabidiol (CBD) is FDA-approved for seizures linked to three specific conditions: Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex, in patients one year of age and older. These are severe childhood epilepsy syndromes that often resist standard medications. The prescription product is distinct from over-the-counter CBD supplements, which are not regulated or tested for seizure treatment. If your child has one of these conditions, this is a conversation to have with their neurologist.
Managing Triggers
Many people with epilepsy notice that certain factors make seizures more likely. Sleep deprivation is one of the most well-documented triggers. Decades of research confirm that losing sleep raises seizure risk, and sleep deprivation is even used deliberately in clinical settings to provoke brain activity that helps diagnose epilepsy. Stress, missed medication doses, alcohol use, illness, and flashing lights (in photosensitive epilepsy) are other commonly reported triggers.
Keeping a seizure diary, whether on paper or through a smartphone app, helps identify personal patterns. Tracking sleep, stress levels, meals, and medication timing alongside seizure occurrences can reveal triggers you might not notice otherwise. Consistent sleep schedules, stress management techniques, and strict medication adherence are some of the simplest and most powerful tools for reducing seizure frequency.
Daily Safety Precautions
If your seizures aren’t fully controlled, some practical adjustments can prevent injuries. Showers are safer than baths, and using a handheld showerhead while seated adds another layer of protection. Keeping the bathroom door unlocked (or using an “occupied” sign instead of a lock) ensures someone can reach you in an emergency. Limiting the water heater’s maximum temperature prevents burns if you lose consciousness near a faucet.
In the kitchen, using back burners, choosing a microwave over a stovetop when possible, and working with pre-cut ingredients all reduce risk. Non-breakable dishes and travel mugs with lids help avoid injuries from falls or spills. For sleeping, keeping the bed low to the ground, or placing the mattress directly on the floor, minimizes the chance of a fall from height.
Driving regulations vary by location, but the general rule is straightforward: don’t drive if you’re having seizures. Most jurisdictions require a seizure-free period of at least six months, along with physician clearance, before you can hold a license. Public transit and carpooling are reliable alternatives in the meantime.
What to Do During a Seizure
Knowing how to help someone mid-seizure matters just as much as long-term treatment. If someone is having a generalized seizure with convulsions, ease them to the ground, turn them gently onto their side with their mouth pointing downward to keep the airway clear, and place something soft under their head. Remove nearby objects that could cause injury, loosen anything tight around their neck, and take off their glasses.
Time the seizure from the start. If it lasts longer than five minutes, call 911. Once the seizure ends, help them sit somewhere safe, explain calmly what happened, and offer to call someone to help them get home. Check for a medical bracelet that may list their condition, medications, and emergency contacts.
Three things to never do: don’t hold the person down or try to restrain their movements, don’t put anything in their mouth (this can break teeth or injure the jaw), and don’t offer food or water until they’re fully alert and oriented.