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Epilepsy Treatment: Finding the Right Medication

Older-Generation Epilepsy Drugs continued...

Depakote or Depakene (valproate, valproic acid) is a broad-spectrum, older generation epilepsy drug effective against most seizure types. Side effects can include nausea and vomiting, tremor, dizziness, clumsiness, weight gain, and slowed thinking. Depakote also can cause osteoporosis and birth defects. It affects liver metabolism and has many potential drug interactions.

Tegretol or Carbatrol (carbamazepine) is a narrow-spectrum epilepsy drug. Its side effects include dizziness, double or blurry vision, clumsiness, and sedation. It can also lower the sodium level in the blood, which must be monitored periodically. Like the other older drugs, it has multiple drug interactions and has a risk of birth defects. Tegretol improves partial seizures, but can aggravate generalized seizures.

Phenobarbital treats both partial and generalized tonic-clonic seizures. Its side effects as a depressant (slowed thinking and fatigue) typically make it an add-on drug only. However, it is the lowest-cost epilepsy drug.

Are Newer Epilepsy Drugs Better?

Is newer better? When it comes to drugs for treating epilepsy, experts answer that question with a resounding "not necessarily."

"The newer drugs, generally speaking, have fewer side effects and drug interactions," says Jacqueline French, MD, spokeswoman for the American Academy of Neurology. "But these decisions are always on an individual, case-by-case basis -- it's impossible to generalize." Limited studies suggest newer epilepsy drugs control seizures as well as the older medicines -- but not better.

So don't count out the older drugs. In one recent high-quality study, valproic acid was more effective than newcomers Lamictal and Topamax. Valproic acid even had fewer people quit taking the drug because of side effects than did Topamax.

Older epilepsy drugs have a longer track record, and most doctors are more familiar with them. They're more widely available on drug formularies, and are less expensive than newer epilepsy drugs.

But with epilepsy drugs, one size definitely does not fit all, or even most. "Finding the best balance in a medicine, between effectiveness and side effects, is very individualized," says Devinsky. "It takes close communication and a partnership with your doctor," especially when switching epilepsy drugs, he adds.

Brand-Name or Generic Epilepsy Drug?

Once you've found the epilepsy drug that's best for you, why not switch to a generic, and start saving money? In general, experts at managing epilepsy say to stick with brand-name epilepsydrugs, if you can.

"If we could guarantee the same generic manufacturer's drug would be given every time, that might be OK," says French. But because pharmacies frequently switch between generic suppliers for lower prices, "some people may get a different generic drug every month," she says.

Although generic drugs are required by the FDA to be very close to the brand-name drug in composition and effects, small variances are allowed. This variability could be even higher between generic drugs by different makers. Evidence is limited, but many epilepsy experts believe frequent switching of generic drugs can cause previously controlled seizures to "break through."

Until clinical studies settle the issue, expert groups and epilepsy advocacy organizations recommend against switching branded for generic epilepsy drugs.

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