The goal in treating epilepsy is to control your seizures so you can focus on life again. Over the last two decades, the number of treatment options has grown. Today, your doctor can choose from more than 20 medicines.
To find the right drug, your doctor will consider a few things, including:
A seizure occurs when there’s abnormal electrical activity in the brain. Seizures may go virtually unnoticed. Or, in severe cases, they may produce a change or loss of consciousness and involuntary muscle spasms called convulsions. Seizures usually come on suddenly and vary in duration and severity. A seizure may be a one-time event, or you may have seizures repeatedly. Recurrent seizures are called epilepsy, or a seizure disorder. Less than one in 10 people who has a seizure develops epilepsy.
Your medical history and tests like an EEG (electroencephalogram) and MRI (magnetic resonance imaging) can help your doctor learn what kind of seizures you're having.
"Some seizures start in just one part of the brain [focal seizures] and some start with the whole brain firing off at the same time [generalized seizures]," says Adam Hartman, MD, assistant professor of neurology and pediatrics at the Johns Hopkins Children's Center. "We think about which medication is most likely to work for a particular patient's seizures."
Your other health conditions also matter. Some epilepsy drugs can interact with medicines you already take. Others serve double duty and can treat a second condition. For example, topiramate (Qudexy XR, Topamax, Topiragen, Trokendi XR) helps both seizures and migraine headaches. Lamotrigine (Lamictal) treats epilepsy plus bipolar disorder.
Generics vs. Brand Names
The doctor will also consider which medicines your insurance will cover. Generic drugs usually cost less than brand names. But do they work as well?
Generally, yes. The FDA requires a generic drug to have the same active ingredient, strength, and quality as its brand-name counterpart. Yet various generic versions of the same drug can differ from one another quite a bit.
Some big-chain drugstores switch generic drugs often to get the best prices, which means you may get bumped from one medicine to another. "We tell patients, if you want to go generic, you have to go to your pharmacy and say, 'Can you guarantee me the same generic?'" says Imad Najm, MD, director of the Cleveland Clinic Epilepsy Center.
Starting on a Medicine
After considering all of these things, your doctor will start you on a medicine. "Usually we start with a single drug at its lowest effective dose," Hartman says. "If someone's seizures are well controlled with a low dose of medication, that's the dose we use."