ENIn Germany, epilepsy is treated by neurologists, including epileptologists who specialise in seizures, and complex cases go to specialist epilepsy centres. Families usually seek help when seizures continue despite one or two medicines, or after a first seizure has frightened everyone. Questions about school, work and driving follow at once.
Epilepsy treatment in Germany starts with two questions: are these really epileptic seizures, and where in the brain do they begin? The plan is built on the answer. This page covers diagnosis, medication, surgery, nerve stimulation and planning the trip; for the wider field, see neurology in Germany.
Can Epilepsy Be Controlled When Medication Has Failed?
Often it can. According to the World Health Organization, up to 70% of people living with epilepsy could live seizure-free if properly diagnosed and treated. When seizures continue, doctors first re-check the diagnosis: the episodes may be a look-alike such as fainting, or the medicine may not suit the seizure type.
If two suitable medicines at an adequate dose have not stopped the seizures, the epilepsy is called drug-resistant. That is a reason to see a specialist epilepsy centre, where the diagnosis is reviewed and other options are weighed: different medicines, surgery, nerve stimulation or a special diet. No doctor can promise seizure freedom in advance.
Diagnosis: Recording a Seizure and Finding Its Source
Diagnosis establishes the type of seizures and their cause, which decide the choice of medicine and whether surgery can be considered. Focal seizures start in one area of the brain, with staring, automatic movements such as lip-smacking or unusual sensations, and can spread into a convulsive seizure. Generalised seizures involve both halves of the brain from the start: convulsive seizures and absences, brief lapses of awareness. Causes may be structural (a scar after injury or stroke, a cortical malformation, a tumour, or hippocampal sclerosis, meaning scarring deep in the temporal lobe), genetic, immune, metabolic or infectious; sometimes none is found.
An EEG records the brain’s electrical activity through electrodes on the scalp and is painless. Deep breathing or a flashing light during the test can bring out changes typical of epilepsy. If the first EEG is normal, it is repeated, sometimes after a sleepless night, which makes such changes more likely.
Long-term video-EEG monitoring takes place in a special unit: for several days, a camera and the EEG record the patient simultaneously. When a seizure occurs, doctors see what it looks like and what the brain is doing. This separates epilepsy from look-alikes such as fainting or non-epileptic seizures and shows where the seizure begins.
MRI follows a special epilepsy protocol, with thin slices in several sequences, to find small structural changes a standard scan can miss; the experience of the doctor reading the images matters too. Before surgery, tests such as PET, memory and language testing and sometimes EEG from electrodes inside the skull may follow. Our page on MRI in Germany explains the scan itself.
Treating Epilepsy with Medication
Medication is the mainstay of treatment, chosen by seizure type, age, other illnesses and other medication; some drugs suit focal seizures, others generalised ones. For women who may become pregnant, the choice takes particular care, as some antiseizure medicines carry risks for the unborn child. Treatment usually starts with one medicine at a low dose that is raised gradually; if it fails or causes side effects, another is tried.
Day to day, much depends on the patient: taking the medicine as prescribed, knowing what to do after a missed dose, and using phone reminders or a pill box. A seizure diary shows the doctor whether treatment works, and regular sleep matters, as lack of sleep can trigger seizures. Only the doctor decides on reducing or stopping medication. The German guideline on first epileptic seizure and epilepsy in adults sets this out in detail.
When Medication Is Not Enough: Surgery and Nerve Stimulation
Surgery is discussed when seizures start in one limited area of the brain that can be removed without harming speech, movement or other key functions. A multidisciplinary team decides after a pre-surgical assessment with video-EEG monitoring, high-resolution MRI and neuropsychological tests, and explains the expected benefits and risks, including to memory. See neurosurgery in Germany for more.
If surgery is not possible, stimulation may be considered. A vagus nerve stimulator is a small device implanted under the skin that sends mild pulses through a thin lead to the nerve in the neck. In selected cases, deep brain stimulation targets the thalamus, deep in the brain. Both aim for fewer, milder seizures rather than their end; few people become seizure-free this way, and the effect builds up over time.
Centres that treat epilepsy include the Department of Epileptology at University Hospital Bonn, headed by Prof. Rainer Surges. Schön Clinic Vogtareuth runs an epilepsy centre for children and adolescents, with paediatric neurology, epilepsy surgery and rehabilitation in one hospital. At Kliniken Schmieder in Allensbach, acute neurology and early rehabilitation is led by Prof. Anastasios Chatzikonstantinou, whose fields include epilepsy. Children’s care, including the high-fat ketogenic diet, is covered under epilepsy treatment in children.
Frequently asked questions
Can epilepsy be cured?
Epilepsy can often be controlled: with the right medicine, many people become seizure-free and live normally on treatment. Some childhood forms go away with age. If medicines fail and seizures start in one area of the brain, surgery aimed at seizure freedom may be discussed, though success cannot be promised.
How is epilepsy treated?
Epilepsy is treated mainly with antiseizure medication, chosen by seizure type and usually taken for years. If two suitable medicines fail, a specialist centre checks whether the area where seizures begin can be removed; otherwise vagus nerve or deep brain stimulation or a ketogenic-type diet may be considered. Regular sleep and no missed doses help too.
Can epilepsy medication ever be stopped?
Sometimes, but only as a joint decision with the doctor after a long seizure-free period, taking into account the type of epilepsy and the EEG findings. The risk of seizures returning is higher than with continued treatment, and a relapse can affect driving and work, so the dose is reduced slowly.
How AlenMed Organises Epilepsy Treatment in Germany
Before the trip we gather seizure descriptions, home videos if available, EEG reports and recordings, MRI images and a list of all medicines tried, with doses. Once they are translated, a doctor at the hospital decides whether an assessment at an epilepsy centre is needed.
A bed for video-EEG monitoring is booked in advance because places are limited. We arrange the hospital’s visa invitation, an interpreter and a cost estimate before travel; the hospital invoices you directly. The estimate covers the epileptologist’s consultation, the days of video-EEG monitoring in a special unit and MRI to an epilepsy protocol; the largest items are the pre-surgical assessment and the operation or stimulator implantation. Medicines taken later at home are not part of the hospital’s estimate. AlenMed’s office is in Munich, and partner clinics are across Germany.
This material is for reference only and is not an offer. The treatment plan is decided by the doctor after an in-person examination.
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