Medicines can control seizures in most people, approximately 60 to 70% of people. However, a person’s response to medicine may vary. Research has shown that when people first start on seizure medicine, only 47% became seizure free with the first medicine. When a second drug was tried, another 13% of people became seizure free. When more than two drugs was tried the response to medicines decreased markedly; only another 4% of people became seizure free after the first two drugs. (1) This study, along with other research, stresses the need for people to seek help for their seizures early and if medicines aren’t working, to see a doctor who specializes in epilepsy. There are many different medicines for seizures and many of these can help, when given for the right type of seizures, at the right dose, and to the right person.
Seizure medicines do not actually "fix" the problems that cause seizures. Instead, they work by trying to stop or suppress the seizures. Before suggesting treatment with a seizure medicine (also called an antiepileptic drug or AED), your doctor usually has made a diagnosis of epilepsy. It is important to openly discuss with your doctor the pros and cons of the different medicines that are available to treat your kind of epilepsy.
Many medicines act on brain cells to affect the way substances move in and out of the cells, or change the way substances called ‘neurotransmitters’ excite (e.g. stimulate) or inhibit (e.g. stop or slow down) the way information is sent from one cell and area of the brain to another. By changing the way brain cells work or send messages, medicines can affect and ideally stop the way seizure activity begins and spreads through the brain.
Scientists are constantly trying to find new ways that medicines could stop or control seizures. Some of the newer medicines work in a different way than the older medicines. It’s hoped that people who don’t respond to the older medicines may find a good response to a drug that works differently in the brain and may have different or less side effects.
The goal of treatment with medicines should be – “No Seizures and No Side Effects”. In reality though, it’s hard for many people to obtain this. They may get good control of their seizures, but have medicine side effects. Sometimes the side effects don’t bother people or are worth the benefits of not having seizures. Other times, the side effects aren’t manageable or cause other health problems.
In other people, seizure medicines help, but don’t make a person seizure free. Whether or not this is ‘good enough’ will depend on the type of seizures, other neurological problems, the way the person responds to the medicine, or side effects, for example. If the first drug helps some, but not enough, usually a second drug will be added. Ideally, a person can be kept on one drug to help lessen side effects, but some people may need two or more medicine to get the best seizure control they can.
While these goals cannot be achieved in everyone, improve your chances by following these steps:
When you are talking to your doctor about trying a new medicine, consider these questions.
References: Kwan P, Brodie MJ. Early identification of refractory epilepsy. New England Journal of Medicine 342(5):314-319, 2000.
Topic Editor: Joseph I. Sirven M.D.
Author: Steven C. Schachter, M.D.
Reviewed: Patricia O. Shafer RN, MN 11/28/12
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