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.
Here's a common scenario for the parent of a child with epilepsy: You find that your son has left his shoes in the middle of the living room floor for the umpteenth time, or that he still hasn't cleaned his room three weeks after you asked him, or that the garbage truck came and went this morning but he never dragged the cans to the curb.
So you decide it's time for a talk. But as you approach your son to lay down the law, you stop short. What if my yelling at him causes a seizure?
This is a common...
"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
No seizures and no side effects: that's the new ideal in treating epilepsy,
according to the Epilepsy Foundation. While experts temper that mantra with a
dash of realism -- "all medicines have side effects," says Devinsky -- they say
many people live with side effects they don't have to.
"After living on the medication for longer than they lived off of it, some
people can't remember who they were off medication," says Devinsky. Switching
to an epilepsy drug with fewer side effects "has a risk, but can be worth it in
quality of life," for people living with sleepiness, fatigue, or confusion caused by their epilepsy drugs,
But choosing the right one? The number of options for treating epilepsy can
be overwhelming -- even to doctors. To help sort them out, WebMD takes a look
at the epilepsy drugs available today.