Epilepsy Treatment: Finding the Right Medication
Starting on a Medicine continued...
Once you're on a drug, you'll wait to see if your seizures improve. "To judge whether the medication is working, we need to look at seizure frequency," Najm says. If you have seizures every day, you should be able to tell within a month if the medicine has relieved them or made them less frequent. For seizures that come only once every few months, you'll have to stay on the medicine longer to see an effect.
About half of people will be seizure-free with the first drug they try. If your seizures don't get better or they only improve a little, your doctor will increase the dose, switch you to a new drug, or add a second drug.
Another reason to switch drugs is if you can't tolerate the side effects, which can range from fatigue and stomachaches to mood changes. When Wendy Wolski's daughter, Devon, was diagnosed with epilepsy at age 6, her doctor started her on levetiracetam (Keppra). But she didn't stay on the drug for long. "It turned my little girl into a monster," Wolski says. "She was very moody and irritable."
In general, newer epilepsy drugs like oxcarbazepine (Trileptal), pregabalin (Lyrica), and topiramate cause fewer side effects than older drugs like carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Tegretol-XR), phenytoin (Dilantin, Dilantin Infatabs), or valproic acid (Alti-Valproic, Depakene, Depakote, Stavzor). Yet any medicine can cause problems.
When Medicines Don't Work
After trying one to three epilepsy drugs, about two-thirds of people find relief from their seizures. What if you're among the one-third of people whose seizures don't improve?
"After that the odds of success go down," Hartman says. "That's where we start thinking about alternative therapies."
Surgery, neurostimulation (an implanted device that disrupts abnormal electrical signals in the brain to stop seizures), and diet are all options if medicine hasn't been effective. You can also join a clinical trial to try a new epilepsy drug being studied.
How to Make the Most of Your Treatment
To increase your odds of treatment success, take the drug exactly as prescribed. If you have any side effects, report them to your doctor -- don't just stop taking the medicine. "Remember that this is a partnership," Hartman says. "Every side effect is worthy to be discussed."
It can take some trial and error to find the treatment that strikes the right balance of seizure relief and side effects. Devon's doctor had to try her on a few different drug combinations and doses. Today, she takes valproic acid and lamotrigine, which seems to be working. "She's been seizure-free for a year and a half," Wolski says. "She's like a normal kid. She's the girl she'd be if she didn't have epilepsy."