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Epilepsy Treatment: Finding the Right Medication

WebMD Feature

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.

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Understanding Seizures -- Diagnosis and Treatment

To decide if your "spells" are seizures, your doctor will: Take a detailed medical history (including a family history of seizures). Gather information about your behavior before, during, and after the episode. It is very important to have someone with you who witnessed the episode and can describe it to the doctor. Do a physical exam These are tests that may be done: An electroencephalogram (EEG) to identify any abnormal electrical misfiring in the brain and help predict the ...

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"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."

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