Epilepsy Treatment: Finding the Right Medication

Taking epilepsy drugs 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.

"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 possible."

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, Devinsky adds.

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.