The most common way to treat epilepsy is to prescribe antiepileptic medications. Many 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 cause of the epilepsy, the person’s lifestyle and age, how often the seizures occur, cost, and, for a woman, the likelihood that she will become pregnant. Typically a neurologist may be involved in helping to choose the best medication for an individual. 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. Certain epilepsy medications may have negative impacts on emotional health or learning for some people.
Some antiepileptic medications are monitored by checking blood levels while others do not need levels checked. For some anticonvulsants, other things in the blood need to be monitored such as the electrolytes (e.g. sodium or potassium) or blood counts (e.g. white blood count, red blood count, platelets). A person with epilepsy should ask their prescribing clinician what blood tests are necessary and how often the blood tests should be obtained.
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.
In addition to medications used on a regular basis to treat epilepsy, there are also medications which might only be given in an emergency to treat 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. Other medications are being developed that can be given nasally or absorbed into the mouth mucosa. Some medications are only given intravenously in an emergency room or hospital setting if a status epilepticus persists.
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 they 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. Some medications can cause birth defects. A woman with epilepsy should discuss her medications with her clinician before becoming pregnant as some may need to be stopped or changed to a different medication and some women may need to take high dose folic acid supplements. Should a woman become pregnant while on medications without this discussion, they should contact their clinician as soon as possible so that medication changes can be made if necessary.
As people age, their metabolism of medication can change and their sensitivity to the side effects of medication can change. This is true in young children where metabolism of some medications can be dramatically different in an infant versus a young child or teen. Also, as children grow, medications dosages may need adjustment to account for their changing weight. Elderly patients or patients with cognitive challenges may be more sensitive to the effects of medicine. Their medication dosages may need to be lower and/or monitored more closely. The effects of certain medicines can sometimes wear off over time, leading to an increase in seizures if the dose is not adjusted. Certain things can alter the metabolism of a medication and/or absorption of a medication. For example, grapefruit juice can affect the breakdown of many drugs, some medications are not absorbed well if taken with food while others need to be taken with food, some medications are absorbed differently if a pill/capsule is cut/chewed/opened, illness such as a viral illness can alter medication metabolism and certain medications can also interact to alter metabolism of anticonvulsants. This can cause too much of the drug to build up in their bodies, which can make the side effects of the drug worse or these mechanisms can increase breakdown of an anticonvulsant lowering the impact of the medication. People taking epilepsy medication should learn about their medication and all the caveats of its use. They should check with their doctor or pharmacist about interactions when starting another medication. They should seek evaluation if their medicine does not appear to be working or if it causes side effects.
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