Taking epilepsydrugs has always been a fact of
life for most people living with epilepsy. And until the 1990s, choosing an
epilepsy drug was comparatively simple: only a handful were available.
In the past 15 years, epilepsy
treatment for controlling seizures has come a long way. The number of
available epilepsy drugs has more than doubled -- improving treatment, but
making decisions more complex. Finding the best epilepsy drug for you, experts
tell WebMD, involves equal parts art and science -- and a bit of chance.
Seizures are the basic indicator of epilepsy. They vary widely:
Staring straight ahead, repetitive swallowing, and lapsing into complete immobility for a few seconds characterize absence (petit mal) seizures, which can recur many times in a day.
Tonic/clonic (grand mal) seizures, which usually last several minutes, typically begin with a loss of consciousness and a fall, followed by rigidity, then jerking motions and incontinence of urine. After the seizure ends, there is usually a period...
"It's not guesswork, but there is definitely an element of trial and error,"
says Steven Schachter, MD, professor of neurology at Harvard Medical School.
"Knowing ahead of time which drug or combination will be best for a particular
person with epilepsy -- we're just not there yet."
That's not for lack of trying. Doctors consider a raft of information about
you when recommending an initial epilepsy drug: your seizure type, age, sex,
medical conditions, and other drugs you're taking. In the end, though, choosing
an epilepsy drug is an educated leap of faith.
"We don't have any reliable way of telling if someone will respond to a
particular medicine, or the degree of side effects they'll experience," says
Schachter. "It's not like choosing an antibiotic, where a culture in the lab
can tell us which drug will work."
Though inexact, the process usually works. Half of people with a new
diagnosis of seizure are seizure-free with the first epilepsy drug they try.
Whenever possible, a single seizure medication should be used to control
seizures; however, many people require combination therapy to achieve this
goal. Complete seizure control with minimal side effects occurs with a single
drug in 70%-80% of patients with partial and generalized seizures; with
combination therapy, this is attained in an additional 10%-15% of patients.
That same success rate raises the stakes in choosing a medicine, experts
say. "Most people stick with what works," says Orrin Devinsky, MD, director of
New York University Comprehensive Epilepsy Center. "So if someone's going to be
on that medicine for 10, 20, 30 years, it should have the fewest side effects