William B. Svoboda, MD, is a retired pediatric neurologist. He is the founder and former Director of Via Christi Epilepsy Center of Wichita, Kansas.

This series of articles about the effects of epilepsy on children's lives and personalities, and how parents can help their child achieve a happy, independent life, is based mostly on an interview with Dr. Svoboda that was conducted by Shawna Cutting, a writer for epilepsy.com.

Do seizures play a bigger part in a kid's life than the medicine or is it the other way around?

I think the seizures are the big part because those are what influence the parents. But seizure medicines are the obnoxious part. It can be embarrassing when you get called to the front of the class to take your pills, for instance.

Do you think medicines have a different impact on children than on adults?

I think there's no doubt that they do. We know that young kids don't handle medicine the same as adults do. Therefore, we may get into problems with funny metabolism. Dilantin is notoriously erratic in children, especially under four years of age. The blood level goes up and down all over the place.

Children are often going through stages of brain development, of hooking up the wiring. Medicines can have an effect on those stages. The whole brain is being developed from the front to the back. So the frontal lobe is sort of like a conductor. If you've got a bad conductor, or one that's made sleepy or inattentive, you've got a brain that doesn't function as well.

Any antiepileptic medication can help or hurt learning. It may help by stopping seizures and discharges that interfere with learning. But it also can cause learning problems. Too much of any medication dulls alertness and brings out learning problems. Too many medications can add up and impair learning. And some children are sensitive to specific seizure medicines even at normal levels.

Besides sleepiness and mental slowness, the main bad effects on learning are impaired memory and recall, interference with attention (especially sustained attention), and interference with the perception of important details. These medicines can also cause behavior problems that interfere with learning.

Rarely, some medications like Dilantin can cause a dropping of intelligence for various reasons, even for children that aren't taking especially large doses. The older seizure medicines were notorious for such side effects but we are finding that some of the newer ones, such as Topamax [topiramate], also can cause major memory and alertness problems. Others, such as Felbatol [felbamate], seem to help learning. Children seem more alert and able to learn better, perhaps because they're having fewer seizures.

What should parents look for if their child is on epilepsy medication?

I think they should watch to see how the child is doing in school. That means parents should be working closely with the teachers and the teachers should be working closely with the doctors. If the teacher and the parents are concerned, then the doctors should be concerned too and should make sure the drug levels are okay. A doctor won't ask about a child's problems with attention to detail or memory unless a parent brings them up first.

Can medications affect a child's personality?

Well, the act of taking them can be embarrassing, so kids can get secretive. On the physical side, these medicines often alter the messenger agents of the brain, the neurotransmitters, which are intimately involved in personality development, anxiety, and such. As long as kids are taking a medicine that does this, especially at higher doses, or if they're taking a bunch of medicines, you see an artificial state of emotionality.

Seizure medicines (some more than others) also can interfere with attention, which can cause problems during social activities. Or they can cause memory problems, so kids may not remember what they were told to do or told not to do. So we look for a change in personality when a kid is taking seizure medicine, and if we see problems we try to review the medicines. The rule of thumb is to use the fewest medicines possible—monotherapy (using only one medicine) is best by far. Instead of seeing how much medicine they can hold, we should be giving them the least they need.

We also need to look at whether a particular medicine is the right one for a particular kid. The Greek saying that what's poison for some is pleasurable for others is true for the effects of medicine. The same medicine that produces bad problems in some people can overcome similar bad problems in others. For instance, phenobarbital can key up a lot of kids, but it can calm down a lot of other kids. We just wish we could tell in advance which group each kid belongs to. Usually kids that have seizures because of some brain damage are more apt to have problems and they are the ones that are more likely to have the bad reactions.

Many effective seizure medicines are available, so if one seems to be causing problems, the doctor may be able to prescribe a different one that will help instead. As a doctor, I try to pick out the medicine according to the child's personality. A child with a left temporal lobe seizure disorder is more apt to have memory problems, so it wouldn't be a good idea to start that child on something like Dilantin or phenobarbital, which are more likely to cause memory problems at higher dosages.

Another example would be a child with new seizures who already is showing signs of hyperactivity, It wouldn't be a good idea to give a medication that is prone to causing hyperactivity.

Similarly, if the child is having behavior problems and seems to be down in the dumps, I may choose Tegretol. Tegretol is an excellent medication for depression, as well as for some behavioral problems—though now and then it may have just the opposite effect. The point is that I am not choosing the medicine just for the seizures; I'm choosing it for the person who has the seizures.

Will the effects you've described disappear if the medicine is reduced or stopped, or will these ways of dealing with the world remain with the child?

I think it is a mixture. It's certainly a lot easier to change prescriptions than to change the world, so we frequently will reevaluate the medicines to find out where we stand and figure out which medicine is the best one for each child. If your child is showing new behavior problems, you and the doctor should consider whether they might be due to new medications.

Do behavior problems ever require medication?

If your child's behavior problems are becoming severe, the doctor may consider giving psychiatric medications (such as antidepressants, stimulants, or tranquilizers) but these should be used only until the most severe "acting out" is past. They should not be a replacement for counseling. Occasionally these medications may trigger seizures, but if they are used conservatively, the risk is small. They may help by keeping the stresses of the emotional state behind the behavior from triggering seizures.