Fifty percent of all patients with newly diagnosed epilepsy will become seizure-free with the first epilepsy drug they try. For the rest, it's try, try again: switching epilepsy medications, adjusting to side effects, and waiting to make sure the new drug works. Others find their seizures are controlled, but they can't tolerate the medication's side effects and need to switch drugs.
Before you ask your doctor if your medication should be switched, make sure you are taking your current medication exactly as prescribed. Missing doses, splitting pills, or not following instructions to the letter could affect your control and the side effects you experience. If you are already complying with your doctor’s instructions, but still are having breakthrough seizures, talk to your neurologist or epileptologist (specialists who are experts in treating epilepsy). Your doctor will evaluate whether you should switch medications.
Symptoms of seizures vary widely, depending on the part of the brain affected by the electrical misfiring. If a very small part of the brain is affected, you might sense only an odd smell or taste. In other cases, you could have hallucinations or convulsions, or you could lose consciousness.
Generalized tonic-clonic. This type of seizure is sometimes preceded by an aura (awareness of a strange odor, taste, or vision). You might lose consciousness, fall, and experience muscle rigidity (stiffness)...
Eventually, up to 70% of people with epilepsy become seizure-free with minimal side effects while taking epilepsy drugs. But switching epilepsy medications takes time and patience. Finding the right epilepsy drug for you can require equal parts art and science -- and sometimes a bit of luck.
Switching Epilepsy Medications: A Small Leap of Faith
Even the best doctors don't know which epilepsy drug will work best in any given person.
When managing epilepsy, doctors take a snapshot of your epilepsy profile: your type of seizures, your age and gender, other medical conditions, medicines you're on or may be on later, your time of life, and epilepsy drugs you've tried in the past.
Based on that information, your doctor may narrow down the field to a few epilepsy drugs to try. But after that, it's an educated leap of faith, experts tell WebMD.
Switching Medications for Epilepsy: How It's Done
What does the process of switching epilepsy medications involve? The events will be different for each person. Experts agree, though, that success depends on a good partnership between you and your doctor. Switching medications may include these steps:
1. Choose a new drug. Your doctor will work closely with you to decide on the next best epilepsy drug worth trying. That includes a detailed discussion about the advantages and disadvantages of the medicine and its likely side effects, as well as rare but potentially serious effects. If you're a young woman, now is the time to discuss any plans for pregnancy. Some medications interact with birth control pills. And women of childbearing age who take seizure medications should also take daily folate supplements. The more you're involved in the process of choosing your epilepsy drug, the better the chances for long-term success.
2. The "double-cover" period. Usually, you'll start taking your new epilepsy drug while still taking the old one. This makes sure you maintain protection from seizures until the new epilepsy drug begins to work. Most epilepsy drugs doses are increased at weekly intervals.
3. Weaning from the older drug (or not). Your doctor may recommend you stay on both epilepsy drugs for a while. Or, he or she may advise you to gradually reduce, then stop the first drug. During this time, you and your loved ones should watch out for and record any seizures. From start to finish, switching epilepsy medications can take several weeks.