Epilepsy Medication

^{Reviewed by: My Child Without Limits Advisory Committee September 2009}

The most common way to treat epilepsy is to prescribe antiepileptic drugs. More than 20 different antiepileptic drugs are now on the market, all with different benefits and side effects. Choosing which drug to prescribe, and what dosage, depends on many different factors, including the type of seizures a person has, the person's lifestyle and age, how often the seizures occur, and, for a woman, the likelihood that she will become pregnant. People with epilepsy should follow their doctor's advice and share any concerns they may have about their medication.

Doctors treating a patient with newly developed epilepsy often prescribe carbamazepine, valproate, lamotrigine, oxcarbazepine, or phenytoin first, unless the epilepsy is a type that is known to require a different kind of treatment.

For absence seizures, ethosuximide is often the primary treatment. Other commonly prescribed drugs include clonazepam, phenobarbital, and primidone. Some relatively new epilepsy drugs include tiagabine, gabapentin, topiramate, levetiracetam, and felbamate.

Other drugs combined with one of the standard drugs or for intractable seizures that do not respond to other medications. A few drugs, such as fosphenytoin, are approved for use only in hospital settings to treat specific problems such as status epilepticus. For people with recurrent severe seizures that can be easily recognized by the person's family, the drug diazepam is now available as a gel that can be administered rectally by a family member. This kind of drug delivery may be able to stop prolonged or repeated seizures before they develop into status epilepticus.

For most people with epilepsy, seizures can be controlled with just one drug at the optimal dosage. Combining medications usually increases side effects such as fatigue and decreased appetite, so doctors usually prescribe monotherapy, or the use of just one drug, whenever possible. Combinations of drugs are sometimes prescribed if monotherapy fails to effectively control a patient's seizures.

The number of times a person needs to take medication each day usually depends on the drug's half-life, (the time it takes for half the drug dose to be metabolized or broken down into other substances in the body.) Some drugs, such as phenytoin and phenobarbital, only need to be taken once a day, while others such as valproate must be taken two or three times a day.

Most side effects of antiepileptic drugs are fairly minor, such as fatigue, dizziness, or weight gain. However, severe and life-threatening side effects such as allergic reactions can occur. Epilepsy medication also may make it more likely for people to develop depression or to lose contact with reality. People with epilepsy should speak with a doctor immediately if they develop any kind of rash while taking their medicine, or if they find themselves depressed or otherwise unable to think in a logical manner. Other danger signs that should be discussed with a doctor immediately are extreme fatigue, staggering or other movement problems, and slurring of words.

People with epilepsy should be aware that their epilepsy medication could react with many other drugs in harmful ways. For this reason, people with epilepsy should always tell their doctors about all the medicines that take. Women should also know that some antiepileptic drugs could reduce the effectiveness of oral contraceptives. So if they are taking birth control pills they should be sure to tell their doctors.

As people get older, they can become more sensitive to the effects of medicine. Therefore, they may need to have their blood levels checked occasionally to see if the dose needs to be changed. The effects of certain medicines can sometimes wear off over time, leading to an increase in seizures if the dose is not adjusted. People should know that some citrus fruit, especially grapefruit juice, could affect the breakdown of many drugs. This can cause too much of the drug to build up in their bodies, which can make the side effects of the drug worse. People taking epilepsy medication should be sure to check with their doctor and/or seek a second medical opinion if their medicine does not appear to be working or if it causes side effects that are not expected or that are uncomfortable.

Next:

Epilepsy Surgerical Options

Download the Introduction to Epilepsy.