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    Best First-Choice Drugs for Epilepsy ID'd

    But Patient Differences Complicate Effort to Simplify Epilepsy Drug Choice

    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 doctor.

    "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 control.

    "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."

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