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Questions to Ask Your Doctor About Epilepsy/Seizures
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Treatment

The medications used to treat patients with epilepsy are called anticonvulsants. Many of these drugs are available and each has a different mechanism of action, but all serve to reduce the frequency of epileptic seizures. These medications can be given for long periods of time.

Treatment options are evaluated initially based on seizure subtype, as certain anticonvulsants may be indicated for treating some forms of epilepsy and contraindicated for others. When making decisions about treatment with a particular agent, the physician should always take into account the patient's entire medical and medication histories, age and gender, and side-effect profile. It is important to evaluate the risks and benefits of treatment for each individual. That said, some general principles apply to treatment.

Monotherapy, treatment with a single agent, is the goal. Seizures can be controlled with one agent in approximately 75% of patients. Management becomes complicated when patients are given medications in combinations. This also risks increasing the number and frequency of side effects, making it less likely that patients will take their medication appropriately.

For medications to work effectively, a relatively constant level of medication must be maintained in the body. This is accomplished by taking medication regularly as directed, without missing doses. The consequences of missed doses may be a single seizure, more devastating multiple seizures, or status epilepticus.

Divided doses may be preferable with some medications, ensuring a more constant level of medication in the bloodstream. Appropriate dosing levels depend on many factors, including the patient's body weight, concomitant medications, and reaction to treatment.

Many neurologists believe brand-name medications are preferable to generic products. Generic medications may be produced by different companies without rigorous standards regarding adequate drug level at a particular dose. Patients who use these medications may therefore be exposed to fluctuating levels of medication. For some people with epilepsy, this can result in loss of seizure control. Brand-name anticonvulsants, meeting stringent standards, provide more confidence in the dose-blood level relationship.

Any medication can cause an allergic reaction. Dermatological problems, including rashes, are not uncommon. Life-threatening reactions, such as the Stevens-Johnson syndrome, can occur. It is essential that patients report any suspected reactions to their physician.

When medications are to be discontinued, it is almost always recommended that they be slowly tapered down in dosage strength because abrupt withdrawal can produce seizures.

Kidney and liver function testing should be performed to evaluate the ability of these organs to metabolize the medication; some drugs will require changing the dosage if function is impaired.

There is still some controversy over whether to treat a patient who has had only a single seizure. Approximately 75% of seizure sufferers have only one seizure and no reoccurrence. In making treatment decisions, it is helpful to look at risk factors that may predict a second seizure. These include lesions of the brain, an abnormal EEG, or a family history of seizure disorders.

Anticonvulsants can reduce the risk of further seizure activity. People who have had more than one seizure should probably be treated with anticonvulsants.

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