mother giving daughter medicine

Antiseizure medications are typically considered for children who have recurrent seizures that are unprovoked (not caused by another medical problem). Rarely, medication may be started in a child after a single seizure, particularly if that seizure was very severe or prolonged, and if the risk of recurrence is felt to be high.

Choosing the Best Medication

There are a lot of medication options and things to consider when choosing a medicine. The two most important factors to consider are the epilepsy type and side effects.

Determining the Epilepsy Type, Epilepsy Syndrome (if present) and Cause (if known)

Certain medicines can be highly effective for one type of seizure, epilepsy or cause. But they may not work for other types or could even make some seizures worse.

Side Effects of the Medicine

All antiseizure medicines have side effects, which can be divided into “non-life-threatening and reversible” versus “potentially life-threatening and often not reversible.” Fortunately the life-threatening and not reversible ones are rare!

  • Non-life-threatening effects are common and may include sedation or sleepiness, behavior, attention and mood problems, impact on appetite, coordination problems, etc.
  • Rare, potentially life-threatening effects include allergic skin rash, which may be severe (Stevens-Johnson syndrome), or liver or bone marrow failure. Some children may be more prone to develop specific types of side effects based on their age, development, ethnicity, possible interactions with other medications they are taking, or side effects to prior medications.

Other factors that are also considered include the following.

Formulation

Medications can come in a number of formulations, including liquids, chew tablets, or swallow tablets. Different formulations can have specific advantages or drawbacks, based on the particular child.

giving infant medicine with dropper
 
  • Liquid Advantages
    • Easier to administer to infant or young child
    • Easier than tablet if person has a G-tube
  • Liquid Disadvantages
    • Many liquids have significant sugar content and may not be compatible with a ketogenic diet
    • Older children may require a relatively large volume of liquid medication
    • Liquid medications may need to be administered more frequently than swallow tablets
  • Chew Tablet Advantages
    • Easy to administer to a younger child who can chew but not swallow pills
  • Chew Tablet Disadvantages
    • Many chew tablets have significant sugar content and may not be compatible with a ketogenic diet
    • Chew tablets cannot be made as a slow or controlled release formulation so they may need to be taken more often than swallow tablets
  • Swallow Tablet Advantages
    • Some swallow tablets have a special coating on the outside so there is slower release of medication. This allow the tablets to be taken less often. This effect is eliminated if the tablet is crushed.
    • Most swallow tablets have limited amounts of sugar and thus are compatible with the ketogenic diet
  • Swallow Tablet Disadvantages
    • This formulation may not be feasible for young children who cannot swallow pills or people who take medication by G tube

Frequency of Dosing (When it is Taken)

The more frequent a medicine is taken (dosing), the higher the likelihood that doses will be missed. Most people can reliably take medicines twice per day. If they need to take medicines more than that, there is a higher chance that doses will be missed.

Insurance Coverage and Cost

Many medications can be quite costly. Some are readily covered by most insurance plans, whereas others are not. Some medications have a high co-pay, which can be very costly for families.

Do you need medication assistance?

Need for Blood or Other Medical Monitoring

Some medications will require frequent blood level monitoring, whereas others will not. Other medications, such as vigabatrin, require careful monitoring of the person’s vision.

How to Take Medications Regularly

Timing

girl with clock and medicine
 

Antiseizure medications should be taken as prescribed to get the best seizure control. Typically, if medications are given twice a day, they should be taken within the same 2-hour window each day.

It is often best to tie giving your child’s medicine to something you regularly do each day. For many families, that is eating breakfast and dinner. Since medication is better tolerated if taken with food, taking medicines at meal times will help protect against tummy upset.

Taking medications with meals at home may not work as well for teens. They should plan to coordinate taking medication with a regular activity, such as brushing their teeth.

Pill Organizer

Most homes can be very busy places. It is not uncommon for one parent to not know if the other has given medication or not. It helps to have a weekly pill organizer, where you can place all doses for the week. It is then much easier to check if the medication has been given or not.

Pill organizers are also helpful for teens who are starting to take responsibility for their own medications. Parents can confirm the dose was taken by checking the organizer.

Reminders

Many parents and teens also rely on smart phone or smart watch alarms, which can work well as reminders to take medication. Seizure diaries or mobile phone text reminders can also be helpful.

Missed Dose Back-up

No matter how organized we are, a medication dose can be forgotten from time to time. It is a good idea to keep an extra dose of medication at your child’s school, daycare or wherever they may spend a fair bit of time. That way, if you remember a dose was missed, you can simply call and ensure they make that up right away.

Many teens also carry an extra dose of medication with them, in case they forget to take their medication before they leave home.

What to Do if Your Child Refuses Medication

girl refusing medicine
 

It is normal for children to refuse medications. It is important for the parent to stay calm if the child is acting out, but to remain firm that the medication must be taken.

  • When medication is prescribed, work with your health care provider to find the best formulation for your child.
  • Sometimes a rewards system, such as a sticker chart, can be used. If the child takes medication well, they get to put a sticker on the chart. After receiving a pre-set number of stickers, the child gets a small prize.

Rarely, behavior can be much more challenging. In such cases, talk to your pediatrician or health care provider. Behavioral psychologists can be very helpful in working through this issue.

What should I do if my child misses a dose?

If your child misses a dose of medication, take it as soon as you realize the dose was missed, even if the next dose is due shortly. Then take the next dose at the regular time.

If you realize you missed a dose at the time the next dose is due, you should still make up the dose. That means taking the missed dose and the regular dose together. However, you should never take 3 doses together.

How and when should teens transition to taking responsibility for their medications?

It is important for a teen with epilepsy to learn about his or her medication and the importance of carefully taking it as their health care provider prescribes. Teens should be given the chance to talk directly with their epilepsy team and be able to ask questions about their medication or possible side effects.

boy with pill organizer
 

Most teens will start transitioning responsibility of medications between 14 and 16 years of age and become independent taking their own medication by age 17-18 years. As this transition process starts, supervision is needed and pill organizers can be very helpful in allowing the parent to confirm that medication was taken.

Teens should also understand possible drug interactions with their seizure medication, particularly the impact of oral contraceptive pills, alcohol and other drugs. This is a conversation they should have with their health care provider.

Authored By: 
Katherine C. Nickels MD
Elaine Wirrell MD
Authored Date: 
02/2020
Reviewed By: 
Elaine Kiriakopoulos MD, MSc
on: 
Tuesday, February 11, 2020