When children and adults are diagnosed with epilepsy, or a seizure disorder, medication treatment is typically recommended. However, before taking antiepileptic medications, there are some important concepts to understand. This column reviews some of the common questions that are asked about anti-epileptic medications.
Question 1: Will this medication take away my epilepsy?
Answer: No, antiepileptic medications control seizures, but they do not take away the underlying cause of the epilepsy. The medications should be considered to be "anti-seizure medications," rather than "anti-epileptic medications." Therefore, the medications are only effective if taken as directed, everyday. After having seizures controlled for several years, some children are able to discontinue anti-seizure medications when their brain matures enough to "outgrow" their epilepsy.
Question 2: I want the safest medication for my type of seizures, without side effects. Which medication is that?
Answer: While there are many different medications used to treat seizures, there is no perfect medication for each seizure type. Seizure medications affect the entire brain, not just the part of the brain causing the seizures. Therefore, all seizure medications can potentially affect learning, memory, and level of awareness. Fortunately, most of the seizure medications are very well tolerated. When treating epilepsy, risk and benefits of the medications should be discussed and the medication regimen tailored to meet the needs of each individual patient. The medications with the lowest risk of side effects are typically recommended first. In addition, for children, medications that do not require intensive blood monitoring are often selected.
Question 3: How does my doctor recommend the best seizure medication for me?
Answer: Epilepsy is often classified as being focal onset or generalized onset. Focal onset seizures start in one area of the brain and then spread to involve other areas of the brain. Generalized onset seizures are thought to have diffuse brain involvement essentially from seizure onset. The different medications for epilepsy can have indications for treating focal onset seizures, generalized onset seizures, and many have indications for treating both types of seizures. Examples of medications used to treat focal onset seizures include oxcarbazepine (Trileptal) and lacosamide (Vimpat). Ethosuximide (Zarontin) is used only to treat generalized absence seizures. Valproic acid (Depakote, Depakene), levetiracetam (Keppra), topiramate (Topamax), and lamotrigine (Lamictal) are examples of medications that can be used to treat both focal onset and generalized onset seizures. Not all medications work for all seizure types. Some medications can make specific seizures worse, while others may be very effective only for particular seizure types. To help select the most appropriate medication, it is important for your doctor to determine what type of seizures you are experiencing.
Question 4: Will the medications stop my seizures?
Answer: Fortunately, medications allow the majority of people to become seizure-free. However, not all seizures are easily controlled with the first medication. When the appropriate medication is selected, the likelihood of seizure freedom with the first medication is approximately 50%. Of those that do not attain seizure freedom, approximately 20% will become seizure free on a third medication. Of the remainder, up to 10% become seizure free on further medication trials.1,2 If you continue to have seizures after a good trial of 2-3 medicines, you should talk with your seizure doctor about alternative therapies, such as surgery, ketogenic diet, or vagal nerve stimulator. These therapies are typically used in addition to, and not in place of, medications for epilepsy.
Question 5: If one medicine doesn't work, can we combine seizure medications?
Answer: If children or adults continue to have seizures on a therapeutic dose of a seizure medication, sometimes more than one medication is used together. This is called "polypharmacy." For some patients, using more than one medication can improve seizure control. It is important to make sure the medications compliment each other and work at different points along the seizure pathway. It is also important to understand that the risk of side effects can also increase. Therefore, if a medication did not help improve seizure control, then you should discuss potentially discontinuing it rather than using it with the next medication. Once a patient is on three medications, there is little likelihood of additional seizure control with adding on further medications.
Question 6: What can I do to help make my seizure medication work better?
Answer: The most important way to improve seizure control is to always take the medication at the recommended dose and recommended schedule. This is essential for good seizure control. Medication doses should be spread out as evenly as possible throughout the day. For some medications, blood levels are followed. If your doctor orders a blood level of your anti-epileptic medication, this blood level should be checked right before your medication is given. This will give your doctor the most accurate blood level. Taking medications properly allows less variability in blood levels, which may decrease the need for higher doses of medications or using multiple medications, and improve seizure control.
Katherine Nickels, M.D.
Last Reviewed: 3/15/11
Article from the March 2011 Epilepsy.com Spotlight Newsletter. Other articles in this issue inclue:
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