Editing Epilepsy (section)

==Management==
[[File:Epilepsy Medical Alert Wrist Bracelets 2018.jpg|thumb|upright=1.4|Wristbands or bracelets denoting their condition are occasionally worn by people with epilepsy should they need medical assistance.]]

The primary goals of epilepsy management are to control seizures, minimize treatment side effects, and optimize quality of life. Management strategies are individualized based on the type of seizures or epilepsy syndrome, the underlying cause when known, the person’s age and comorbidities, and their preferences and life circumstances.<ref name="NICE2022" />

Supporting people's [[self care|self-management]] of their condition may be useful.<ref>{{cite journal | vauthors = Helmers SL, Kobau R, Sajatovic M, Jobst BC, Privitera M, Devinsky O, Labiner D, Escoffery C, Begley CE, Shegog R, Pandey D, Fraser RT, Johnson EK, Thompson NJ, Horvath KJ | title = Self-management in epilepsy: Why and how you should incorporate self-management in your practice | journal = Epilepsy & Behavior | volume = 68 | pages = 220–224 | date = March 2017 | pmid = 28202408 | pmc = 5381244 | doi = 10.1016/j.yebeh.2016.11.015 }}</ref> In drug-resistant cases different [[management of drug-resistant epilepsy|management options]] may be considered, including special diets, the implantation of a [[neurostimulator]], or [[neurosurgery]].

===First aid and acute management of seizures===
During a generalized tonic–clonic seizure, the primary goals are to ensure safety and prevent injury. The following steps should be taken:<ref name="Mic2011">{{cite journal |vauthors=Michael GE, O'Connor RE |date=February 2011 |title=The diagnosis and management of seizures and status epilepticus in the prehospital setting |journal=Emergency Medicine Clinics of North America |volume=29 |issue=1 |pages=29–39 |doi=10.1016/j.emc.2010.08.003 |pmid=21109100}}</ref>

* Stay calm and remove any potential hazards from the area. Clear the space of sharp objects, furniture, or anything that might cause injury.
* If the person is standing, gently guide them to the ground to avoid a fall.
* Position the person on their side and into the [[recovery position]], which helps keep the airway clear and reduces the risk of choking. If possible, place something soft (e.g., a jacket or cushion) under their head to prevent injury.
* Do not restrain their movements or attempt to hold them down. Do not put anything in their mouth, as this may cause harm.<ref name="EB06" /><ref name="Mic2011" />

If the seizure lasts longer than 5 minutes or if multiple seizures occur without full recovery in between, it is important to call for emergency medical assistance immediately, as it is considered a [[medical emergency]] known as [[status epilepticus]].<ref>{{cite book |url=https://books.google.com/books?id=4W7UI-FPZmoC&pg=PA144 |title=Advanced therapy in epilepsy |vauthors=Wheless JW, Willmore J, Brumback RA |publisher=People's Medical Pub. House |year=2009 |isbn=978-1-60795-004-2 |location=Shelton, Conn. |page=144}}</ref> 

Convulsive status epilepticus requires immediate medical attention to prevent serious complications. In a community setting (such as at home or in the [[ambulance]]), first-line treatment includes the administration of [[Benzodiazepine|benzodiazepines]]. If the person has an individualized emergency management plan — which may have been developed with healthcare providers and outlines personalized treatment steps (such as the use of buccal [[midazolam]] or rectal [[diazepam]]) — this plan should be followed immediately.<ref name="NICE2022" /> In hospital, intravenous [[lorazepam]] is preferred.<ref name="NICE2022" />

If seizures continue after the first dose of benzodiazepine, emergency medical services should be contacted, and further doses can be given. For ongoing seizures, [[levetiracetam]], [[phenytoin]], or [[Valproate|sodium valproate]] may be used as second-line treatments, with levetiracetam preferred for its quicker action and fewer side effects.<ref name="NICE2022" />

Most institutions have a preferred pathway or protocol to be used in a seizure emergency like status epilepticus. These protocols have been found to be effective in reducing time to delivery of treatment.<ref name="NICE2022" />

===Medications===
[[File:Anticonvulsants.jpg|thumb|upright=1.4|Anticonvulsant]]
The primary treatment for epilepsy involves the use of [[Anticonvulsant|antiseizure medications]] (ASMs), which aim to control seizures while minimizing side effects. Treatment plans should be individualized, taking into account the seizure type, epilepsy syndrome, patient age, sex, comorbidities, lifestyle factors, and the potential for drug interactions.<ref name="NICE2022" />

First-line treatment for most individuals with epilepsy is monotherapy with a single ASM. For many people with epilepsy, seizure control is achieved with a single medication, but some may require combination therapy if seizures are not well-controlled with monotherapy.<ref name="NICE2022" />

<!-- Medication by type -->
There are a number of medications available including phenytoin, [[carbamazepine]] and [[valproate]]. Evidence suggests that these drugs are similarly effective for both focal and generalized seizures, although their side-effect profiles vary.<ref>{{cite journal |vauthors=Nevitt SJ, Marson AG, Tudur Smith C |title=Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=7 |pages=CD001911 |date=July 2019 |pmid=31318037 |pmc=6637502 |doi=10.1002/14651858.CD001911.pub4}}</ref><ref>{{cite journal |vauthors=Nevitt SJ, Marson AG, Weston J, Tudur Smith C |title=Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review |journal=The Cochrane Database of Systematic Reviews |volume=2018 |issue=8 |pages=CD001769 |date=August 2018 |pmid=30091458 |pmc=6513104 |doi=10.1002/14651858.CD001769.pub4}}</ref> [[Controlled release]] carbamazepine appears to work as well as immediate release carbamazepine, and may have fewer [[side effect]]s.<ref>{{cite journal |last1=Powell |first1=Graham |last2=Saunders |first2=Matthew |last3=Rigby |first3=Alexandra |last4=Marson |first4=Anthony G |title=Immediate-release versus controlled-release carbamazepine in the treatment of epilepsy |journal=Cochrane Database of Systematic Reviews |date=9 December 2016 |volume=2017 |issue=4 |pages=CD007124 |doi=10.1002/14651858.CD007124.pub5 |pmid=27933615 |pmc=6463840 }}</ref> In the UK, carbamazepine or [[lamotrigine]] are recommended as first-line treatments for focal seizures, with [[levetiracetam]] and valproate used as second-line treatments due to concerns about cost and side effects. Valproate is the first-line choice for generalized seizures, while lamotrigine is used as second-line. For absence seizures, [[ethosuximide]] or valproate are recommended, with valproate also being effective for myoclonic and tonic–clonic seizures.<ref name="NICE2022" /><ref>{{cite journal |vauthors=Nevitt SJ, Sudell M, Cividini S, Marson AG, Tudur Smith C |date=April 2022 |title=Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=4 |pages=CD011412 |doi=10.1002/14651858.CD011412.pub4 |pmc=8974892 |pmid=35363878}}</ref>

Controlled-release formulations of carbamazepine may be preferred in some cases, as they appear to be equally effective as immediate-release carbamazepine but may have fewer side effects. Once a person’s seizures are well-controlled on a specific treatment, it is generally not necessary to routinely check medication blood levels, unless there are concerns about side effects or toxicity.<ref name="NICE2022" />

<!--Developing world  -->
In [[low- and middle-income countries]] (LMICs), the management of epilepsy is often hindered by limited access to medications, diagnostic tools, and specialized care.<ref name="Poor2012" /> While phenytoin and carbamazepine are commonly used as first-line treatments due to their availability and low cost, newer drugs like levetiracetam and lamotrigine may not be accessible. Additionally, surgical options and advanced therapies, such as vagus nerve stimulation or resective surgery, are typically inaccessible due to high costs and lack of infrastructure. 

The least expensive anticonvulsant is [[phenobarbital]] at around US$5 a year.<ref name="Poor2012" /> The [[World Health Organization]] gives it a first-line recommendation in LMICs and it is commonly used in these countries.<ref>{{cite journal | vauthors = Ilangaratne NB, Mannakkara NN, Bell GS, Sander JW | title = Phenobarbital: missing in action | journal = Bulletin of the World Health Organization | volume = 90 | issue = 12 | pages = 871–871A | date = December 2012 | pmid = 23284189 | pmc = 3524964 | doi = 10.2471/BLT.12.113183 }}</ref><ref>{{cite book | veditors = Shorvon S, Perucca E, Engel Jr J |title=The treatment of epilepsy|year=2009|publisher=Wiley-Blackwell|location=Chichester, UK|isbn=978-1-4443-1667-4|page=587|url=https://books.google.com/books?id=rFFzFzZJtasC&pg=PA587|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20160521102931/https://books.google.com/books?id=rFFzFzZJtasC&pg=PA587|archive-date=21 May 2016}}</ref> Access, however, may be difficult as some countries label it as a [[controlled drug]].<ref name="Poor2012" />

<!--Side effects  -->
Adverse effects from medications are reported in 10% to 90% of people, depending on how and from whom the data is collected.<ref name="Per2012" /> Most adverse effects are dose-related and mild.<ref name="Per2012" /> Some examples include mood changes, sleepiness, or an unsteadiness in gait.<ref name="Per2012" /> Certain medications have side effects that are not related to dose such as rashes, liver toxicity, or [[aplastic anemia|suppression of the bone marrow]].<ref name="Per2012" /> Up to a quarter of people stop treatment due to adverse effects.<ref name="Per2012" /> Some medications are associated with [[birth defect]]s when used in pregnancy.<ref name="National Clinical Guideline 57_83">{{cite book |author=National Clinical Guideline Centre |url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care |date=January 2012 |publisher=National Institute for Health and Clinical Excellence |pages=57–83 |archive-url=https://web.archive.org/web/20131216151008/http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |archive-date=16 December 2013 |url-status=live}}</ref> Many of the common used medications, such as valproate, phenytoin, carbamazepine, phenobarbital, and gabapentin have been reported to cause increased risk of birth defects,<ref name="Bromley_2023">{{cite journal | vauthors = Bromley R, Adab N, Bluett-Duncan M, Clayton-Smith J, Christensen J, Edwards K, Greenhalgh J, Hill RA, Jackson CF, Khanom S, McGinty RN, Tudur Smith C, Pulman J, Marson AG | title = Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 8 | pages = CD010224 | date = August 2023 | pmid = 37647086 | pmc = 10463554 | doi = 10.1002/14651858.CD010224.pub3 }}</ref> especially when used during the [[first trimester]].<ref name="Kam2013" /> Despite this, treatment is often continued once effective, because the risk of untreated epilepsy is believed to be greater than the risk of the medications.<ref name="Kam2013">{{cite journal | vauthors = Kamyar M, Varner M | title = Epilepsy in pregnancy | journal = Clinical Obstetrics and Gynecology | volume = 56 | issue = 2 | pages = 330–341 | date = June 2013 | pmid = 23563876 | doi = 10.1097/GRF.0b013e31828f2436 }}</ref> Among the antiepileptic medications, levetiracetam and lamotrigine seem to carry the lowest risk of causing birth defects.<ref name="Bromley_2023" />

<!--Tapering  -->
Slowly stopping medications may be reasonable in some people who do not have a seizure for two to four years; however, around a third of people have a recurrence, most often during the first six months.<ref name="National Clinical Guideline 57_83" /><ref>{{cite book|title=Adolescent health care: a practical guide|year=2008|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-9256-1|page=335|url=https://books.google.com/books?id=er8dQPxgcz0C&pg=PA335|edition=5th|editor=Lawrence S. Neinstein}}</ref> Stopping is possible in about 70% of children and 60% of adults.<ref name=WHO2012/> Measuring medication levels is not generally needed in those whose seizures are well controlled.<ref name=Wise2018>{{cite web |title=American Epilepsy Society Choosing Wisely |url=http://www.choosingwisely.org/societies/american-epilepsy-society/ |website=www.choosingwisely.org |date=14 August 2018 |access-date=30 August 2018}}</ref>

===Surgery===
[[Epilepsy surgery]] is an important treatment option for individuals with [[Management of drug-resistant epilepsy|drug-resistant epilepsy]],<ref name="pmid19800848" /><ref name="Engel2018">{{Cite journal |last=Engel |first=Jerome |date=2018 |title=The current place of epilepsy surgery |url=https://pubmed.ncbi.nlm.nih.gov/29278548 |journal=Current Opinion in Neurology |volume=31 |issue=2 |pages=192–197 |doi=10.1097/WCO.0000000000000528 |issn=1473-6551 |pmc=6009838 |pmid=29278548}}</ref> typically defined as the failure of at least two appropriately chosen and tolerated antiseizure medications.<ref>{{Cite journal |last=Kwan |first=P. |last2=Brodie |first2=M. J. |date=2000-02-03 |title=Early identification of refractory epilepsy |url=https://pubmed.ncbi.nlm.nih.gov/10660394 |journal=The New England Journal of Medicine |volume=342 |issue=5 |pages=314–319 |doi=10.1056/NEJM200002033420503 |issn=0028-4793 |pmid=10660394}}</ref> Surgery is most effective in cases of focal epilepsy, where seizures originate from a specific area of the brain that can be safely removed.<ref name="pmid7361318">{{cite journal |vauthors=Benoit PW, Yagiela A, Fort NF |date=February 1980 |title=Pharmacologic correlation between local anesthetic-induced myotoxicity and disturbances of intracellular calcium distribution |journal=Toxicology and Applied Pharmacology |volume=52 |issue=2 |pages=187–198 |bibcode=1980ToxAP..52..187B |doi=10.1016/0041-008x(80)90105-2 |pmid=7361318}}</ref><ref name="pmid28994113">{{cite journal |vauthors=Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ |date=December 2017 |title=Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review |journal=Epilepsia |volume=58 |issue=12 |pages=2133–2142 |doi=10.1111/epi.13920 |pmc=5716856 |pmid=28994113}}</ref>

Although epilepsy surgery has demonstrated strong evidence of efficacy — especially in drug-resistant focal epilepsy — it remains underutilized worldwide and is often reserved for individuals whose condition has reached an advanced or chronic stage.<ref name="Engel2018" /> Early consideration and referral for surgical evaluation can improve long-term outcomes and quality of life. This evaluation, conducted in specialized epilepsy centers, includes seizure classification, long-term video EEG monitoring, high-resolution MRI with epilepsy-specific protocols, neuropsychological assessment, and sometimes functional imaging or invasive monitoring. Early referral improves the likelihood of successful outcomes and avoids prolonged periods of unnecessary disability.<ref>{{Cite journal |last=Rosenow |first=Felix |last2=Bast |first2=Thomas |last3=Czech |first3=Thomas |last4=Feucht |first4=Martha |last5=Hans |first5=Volkmar H. |last6=Helmstaedter |first6=Christoph |last7=Huppertz |first7=Hans-Jürgen |last8=Noachtar |first8=Soheyl |last9=Oltmanns |first9=Frank |last10=Polster |first10=Tilman |last11=Seeck |first11=Margitta |last12=Trinka |first12=Eugen |last13=Wagner |first13=Kathrin |last14=Strzelczyk |first14=Adam |date=2016 |title=Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment |url=https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13449 |journal=Epilepsia |language=en |volume=57 |issue=8 |pages=1215–1220 |doi=10.1111/epi.13449 |issn=1528-1167}}</ref>

The primary goal of epilepsy surgery is to achieve seizure freedom,<ref name="pmid12027916">{{cite journal |vauthors=Birbeck GL, Hays RD, Cui X, Vickrey BG |date=May 2002 |title=Seizure reduction and quality of life improvements in people with epilepsy |journal=Epilepsia |volume=43 |issue=5 |pages=535–538 |doi=10.1046/j.1528-1157.2002.32201.x |pmid=12027916 |doi-access=free}}</ref> but even when that is not possible, palliative procedures that significantly reduce seizure frequency can lead to meaningful improvements in quality of life and development — particularly in children. Studies suggest that 60-70% of individuals with drug-resistant focal epilepsy experience a substantial reduction in seizures following surgery.<ref name="pmid17491501">{{cite journal |vauthors=Duncan JS |date=April 2007 |title=Epilepsy surgery |journal=Clinical Medicine |volume=7 |issue=2 |pages=137–142 |doi=10.7861/clinmedicine.7-2-137 |pmc=4951827 |pmid=17491501}}</ref>

Common procedures include anterior temporal lobe resection, which often involves removal of the hippocampus in cases of mesial temporal lobe epilepsy, as well as lesionectomy for tumors or cortical dysplasia, and lobectomy for larger seizure foci.<ref name="pmid17491501" /> In cases where resection is not possible, procedures such as [[corpus callosotomy]] may help reduce the severity and spread of seizures. In addition to traditional resective techniques, minimally invasive approaches such as MRI-guided laser interstitial thermal therapy (LITT) have gained traction as safer alternatives in select cases, particularly where reducing cognitive impact and recovery time is a priority.<ref>{{Cite journal |last=Sharma |first=Mayur |last2=Ball |first2=Tyler |last3=Alhourani |first3=Ahmad |last4=Ugiliweneza |first4=Beatrice |last5=Wang |first5=Dengzhi |last6=Boakye |first6=Maxwell |last7=Neimat |first7=Joseph S. |date=2020-04-01 |title=Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis |url=https://thejns.org/focus/view/journals/neurosurg-focus/48/4/article-pE11.xml |journal=Neurosurgical Focus |language=en-US |volume=48 |issue=4 |pages=E11 |doi=10.3171/2020.1.FOCUS19935 |issn=1092-0684|doi-access=free }}</ref> In many cases, antiseizure medications can be tapered following successful surgery, though long-term monitoring remains essential.<ref name="pmid28994113" /><ref name="pmid17491501" /> Surgical treatment is not limited to adults. A 2023 systematic review found that early surgery in children under 3 years with drug-resistant epilepsy can result in meaningful seizure reduction or freedom when other treatments have failed.<ref>{{Cite journal |last1=Tsou |first1=Amy Y. |last2=Kessler |first2=Sudha Kilaru |last3=Wu |first3=Mingche |last4=Abend |first4=Nicholas S. |last5=Massey |first5=Shavonne L. |last6=Treadwell |first6=Jonathan R. |date=2023-01-03 |title=Surgical Treatments for Epilepsies in Children Aged 1–36 Months: A Systematic Review |journal=Neurology |volume=100 |issue=1 |pages=e1–e15 |doi=10.1212/WNL.0000000000201012 |pmc=9827129 |pmid=36270898}}</ref>

Although epilepsy surgery has demonstrated efficacy, it is still rarely used around the world, and is typically reserved for cases where the condition has reached an advanced stage.<ref name="Engel2018" />

==== Neuromodulation ====
[[Neurostimulation|Neuromodulation]] therapies, including [[vagus nerve stimulation]] (VNS), [[deep brain stimulation]] (DBS), and [[Responsive neurostimulation device|responsive neurostimulation]] (RNS), are treatment options for individuals with drug-resistant epilepsy who are not candidates for resective surgery, or for whom previous surgery has not resulted in seizure freedom.<ref name="Cochrane2015">{{cite journal |vauthors=Panebianco M, Rigby A, Marson AG |date=July 2022 |title=Vagus nerve stimulation for focal seizures |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=7 |pages=CD002896 |doi=10.1002/14651858.CD002896.pub3 |pmc=9281624 |pmid=35833911 |doi-access=free}}</ref><ref name="Edwards2017">{{cite journal |vauthors=Edwards CA, Kouzani A, Lee KH, Ross EK |date=September 2017 |title=Neurostimulation Devices for the Treatment of Neurologic Disorders |journal=Mayo Clinic Proceedings |volume=92 |issue=9 |pages=1427–1444 |doi=10.1016/j.mayocp.2017.05.005 |pmid=28870357 |doi-access=free}}</ref><ref>{{Cite journal |last=Englot |first=Dario J |last2=Chang |first2=Edward F. |last3=Auguste |first3=Kurtis I |date=2011 |title=Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response |url=https://pubmed.ncbi.nlm.nih.gov/21838505 |journal=Journal of Neurosurgery |volume=115 |issue=6 |pages=1248–1255 |doi=10.3171/2011.7.JNS11977 |issn=1933-0693 |pmid=21838505}}</ref> These therapies aim to reduce seizure frequency and severity by delivering controlled electrical stimulation to targeted neural circuits.

===Diet===
Dietary therapy, particularly the [[ketogenic diet]] (high-fat, [[low-carbohydrate diet|low-carbohydrate]], adequate-[[protein (nutrient)|protein]]), is a non-pharmacological treatment option used primarily in children with drug-resistant epilepsy. Evidence suggests that children on a classical ketogenic diet may be up to three times more likely to achieve seizure freedom and up to six times more likely to experience a ≥50% reduction in seizure frequency compared to those receiving standard care. Modified versions of the diet, such as the modified Atkins diet, are better tolerated but may be less effective.<ref name="Mar2018" /><ref>{{cite report |title=Management of Infantile Epilepsies: A Systematic Review |date=2022 |doi=10.23970/AHRQEPCCER252 |pmid=36383706 |vauthors=Treadwell JR, Wu M, Tsou AY}}</ref> In adults, the ketogenic diet has shown limited evidence of achieving seizure freedom, though it may increase the likelihood of seizure reduction. However, further research is necessary.<ref name="Mar2018" /> 

It is typically supervised by a multidisciplinary team, including neurologists and dietitians, due to its restrictive nature and potential side effects, such as vomiting, constipation and diarrhoea. Regular monitoring of nutritional status, blood parameters, and growth is recommended.<ref name="Mar2018" /> It is unclear why this diet works.<ref>{{cite book |url=https://books.google.com/books?id=lxhs51fE85wC&pg=PA180 |title=Current management in child neurology |publisher=BC Decker |year=2009 |isbn=978-1-60795-000-4 |veditors=Maria BL |edition=4th |location=Hamilton, Ont. |page=180 |archive-url=https://web.archive.org/web/20160624092756/https://books.google.com/books?id=lxhs51fE85wC&pg=PA180 |archive-date=24 June 2016 |url-status=live}}</ref> A [[gluten-free diet]] has been proposed in rare cases of epilepsy associated with [[celiac disease]] and occipital calcifications, though evidence is limited and based on small case series.<ref name="JacksonEaton2012" />

=== Adjunctive and complementary therapies ===
There is moderate-quality evidence supporting the use of psychological interventions — such as cognitive behavioral therapy (CBT), relaxation techniques, and self-management training — alongside standard treatment.<ref name="CD012081">{{cite journal |vauthors=Michaelis R, Tang V, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Lundgren T, Reuber M |date=October 2017 |title=Psychological treatments for people with epilepsy |journal=The Cochrane Database of Systematic Reviews |volume=10 |issue=10 |pages=CD012081 |doi=10.1002/14651858.CD012081.pub2 |pmc=6485515 |pmid=29078005}}</ref> These approaches may improve quality of life, emotional wellbeing, and treatment adherence; however, evidences targeting seizure control are uncertain.<ref>{{Cite journal |last=Li |first=Dongxu |last2=Song |first2=Yuqi |last3=Zhang |first3=Shuyu |last4=Qiu |first4=Juan |last5=Zhang |first5=Rui |last6=Wu |first6=Jiayi |last7=Wu |first7=Ziyan |last8=Wei |first8=Junwen |last9=Xiang |first9=Xuefeng |last10=Zhang |first10=Yue |last11=Yu |first11=Liangdong |last12=Wang |first12=Honghan |last13=Niu |first13=Ping |last14=Fan |first14=Chuan |last15=Li |first15=Xiaoming |date=2023-01-01 |title=Cognitive behavior therapy for depression in people with epilepsy: A systematic review and meta-analysis |url=https://www.sciencedirect.com/science/article/abs/pii/S1525505022005054 |journal=Epilepsy & Behavior |volume=138 |pages=109056 |doi=10.1016/j.yebeh.2022.109056 |issn=1525-5050}}</ref> Avoidance therapy consists of minimizing or eliminating triggers. For example, those who are sensitive to light may have success with using a small television, avoiding video games, or wearing dark glasses.<ref>{{cite journal |vauthors=Verrotti A, Tocco AM, Salladini C, Latini G, Chiarelli F |date=November 2005 |title=Human photosensitivity: from pathophysiology to treatment |journal=European Journal of Neurology |volume=12 |issue=11 |pages=828–841 |doi=10.1111/j.1468-1331.2005.01085.x |pmid=16241971}}</ref> [[Biofeedback]], particularly EEG-based operant conditioning, has shown preliminary benefit in some people with drug-resistant epilepsy.<ref>{{cite journal |vauthors=Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA |date=July 2009 |title=Meta-analysis of EEG biofeedback in treating epilepsy |journal=Clinical EEG and Neuroscience |volume=40 |issue=3 |pages=173–179 |doi=10.1177/155005940904000310 |pmid=19715180}}</ref> However, these methods are considered adjunctive and are not recommended as standalone treatments.

[[Cannabidiol]] (CBD) has shown benefit as an add-on therapy in certain severe childhood epilepsies. A purified form of CBD was approved by the U.S. FDA in 2018 and by the European Medicines Agency (EMA) in 2020 for the treatment of Dravet syndrome, Lennox–Gastaut syndrome, and tuberous sclerosis complex.<ref>{{cite journal |vauthors=Stockings E, Zagic D, Campbell G, Weier M, Hall WD, Nielsen S, Herkes GK, Farrell M, Degenhardt L |date=July 2018 |title=Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=89 |issue=7 |pages=741–753 |doi=10.1136/jnnp-2017-317168 |pmid=29511052 |doi-access=free |hdl-access=free |hdl=1959.4/unsworks_50076}}</ref><ref>{{cite report |title=Cannabis derivative may reduce seizures in some severe drug-resistant epilepsies, but adverse events increase |date=26 June 2018 |doi=10.3310/signal-000606}}</ref><ref>{{cite web |date=25 June 2018 |title=Press Announcements - FDA approves first drug {{sic|comprised |hide=y|of}} an active ingredient derived from marijuana to treat rare, severe forms of epilepsy |url=https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm |access-date=4 October 2018 |website=www.fda.gov |language=en}}</ref>

Regular [[physical activity]] is generally considered safe and may have beneficial effects on seizure frequency, mood, and overall wellbeing.<ref>{{cite journal |vauthors=Arida RM, Scorza FA, Scorza CA, Cavalheiro EA |date=March 2009 |title=Is physical activity beneficial for recovery in temporal lobe epilepsy? Evidences from animal studies |journal=Neuroscience and Biobehavioral Reviews |volume=33 |issue=3 |pages=422–431 |doi=10.1016/j.neubiorev.2008.11.002 |pmid=19059282}}</ref> While evidence remains limited, some studies suggest that moderate exercise can reduce seizure burden in certain individuals.<ref>{{cite journal |vauthors=Arida RM, Cavalheiro EA, da Silva AC, Scorza FA |year=2008 |title=Physical activity and epilepsy: proven and predicted benefits |journal=Sports Medicine |volume=38 |issue=7 |pages=607–615 |doi=10.2165/00007256-200838070-00006 |pmid=18557661}}</ref> Seizure response dogs have been trained to assist individuals during or after seizures by providing physical support or alerting others.<ref name="eddivito2010">{{cite journal |vauthors=Di Vito L, Naldi I, Mostacci B, Licchetta L, Bisulli F, Tinuper P |date=June 2010 |title=A seizure response dog: video recording of reacting behaviour during repetitive prolonged seizures |journal=Epileptic Disorders |volume=12 |issue=2 |pages=142–145 |doi=10.1684/epd.2010.0313 |pmid=20472528}}</ref><ref name="ebkirton2008">{{cite journal |vauthors=Kirton A, Winter A, Wirrell E, Snead OC |date=October 2008 |title=Seizure response dogs: evaluation of a formal training program |journal=Epilepsy & Behavior |volume=13 |issue=3 |pages=499–504 |doi=10.1016/j.yebeh.2008.05.011 |pmid=18595778}}</ref> Although anecdotal reports claim that some dogs can anticipate seizures, there is no conclusive scientific evidence supporting the consistent ability of dogs to predict seizures before they occur.<ref name="Doh2007">{{cite journal |vauthors=Doherty MJ, Haltiner AM |date=January 2007 |title=Wag the dog: skepticism on seizure alert canines |journal=Neurology |volume=68 |issue=4 |pages=309 |doi=10.1212/01.wnl.0000252369.82956.a3 |pmid=17242343}}</ref>

Various forms of alternative medicine, including [[acupuncture]],<ref>{{cite journal | vauthors = Cheuk DK, Wong V | title = Acupuncture for epilepsy | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 5 | pages = CD005062 | date = May 2014 | pmid = 24801225 | pmc = 10105317 | doi = 10.1002/14651858.CD005062.pub4 }}</ref> routine [[vitamins]],<ref>{{cite journal | vauthors = Ranganathan LN, Ramaratnam S | title = Vitamins for epilepsy | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD004304 | date = April 2005 | pmid = 15846704 | doi = 10.1002/14651858.CD004304.pub2 }}</ref> and [[yoga]],<ref>{{cite journal | vauthors = Panebianco M, Sridharan K, Ramaratnam S | title = Yoga for epilepsy | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 10 | pages = CD001524 | date = October 2017 | pmid = 28982217 | pmc = 6485327 | doi = 10.1002/14651858.CD001524.pub3 }}</ref> have no reliable [[Evidence-based medicine|evidence]] to support their use in epilepsy. [[Melatonin]], {{as of|2016|lc=y}}, is insufficiently supported by evidence.<ref name=Brigo2016>{{cite journal | vauthors = Brigo F, Igwe SC, Del Felice A | title = Melatonin as add-on treatment for epilepsy | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 8 | pages = CD006967 | date = August 2016 | pmid = 27513702 | pmc = 7386917 | doi = 10.1002/14651858.CD006967.pub4 }}</ref> The trials were of poor methodological quality and it was not possible to draw any definitive conclusions.<ref name=Brigo2016 />