Best First-Choice Drugs for Epilepsy ID'd
But Patient Differences Complicate Effort to Simplify Epilepsy Drug Choice
WebMD News Archive
Epilepsy Drug Choice Still Complex
Marson's study looked at how well the epilepsy drugs control seizures, their
general tolerability, and their cost.
Those are important things, French says. But other things are equally
important, such as the likelihood a drug will cause a serious health risk or a
drug's interactions with other medications.
For example, some epilepsy drugs make oral contraceptives less effective.
And oral contraceptives, French says, make Lamictal less effective.
"Patients with epilepsy should think about the things that are important
for them," French advises. "Say I want to get pregnant in the next five
years. Or I am very nervous about side effects that might seriously compromise
my health. Or I need protection against seizures from day one, which Lamictal
is not going to do."
Marson agrees that the SANAD studies don't answer all these questions. But
the studies do offer important new information to guide patient choices.
The most important choice patients make, French says, is their choice of
"A person should definitely ask, 'What kind of epilepsy do I have?' And
if a doctor can't answer that question, it is time to find another doctor.
Because not everybody should be treating epilepsy," French says.
French says that about half of patients get excellent seizure control with
any of the available epilepsy drugs. The problem, she and Marson agree, is that
nobody can predict which patients will respond to treatment and which are among
the 30% of patients for whom none of the drugs offers sufficient seizure
"There are some new drugs in the pipeline. We hope one will make a big
impact," French says. "But over the last decade and a half we thought
we were incredibly successful by making 10 new drugs available. And yet we have
not even made a dent in the number of treatment-resistant patients. That is
enormously frustrating. But we'll keep trying."
That's important for far more people than is generally appreciated.
"Nobody realizes how prevalent this problem is because it is so poorly
accepted by the community at large," French says. "Patients try as hard
as they can to keep anybody from knowing. They keep it hidden."