There are a wide number of medications available for treating epilepsy in children and advances in the past years have made a difference. In fact, nine new drugs have become available in the last decade, says William R. Turk, MD, Chief of the Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida.
But that doesn't mean the newest drug for epilepsy is the best. Turk says that while new medications have helped, there's no single miracle cure responsible for the improvements in treating epilepsy. Instead, doctors are getting better at fine-tuning treatment for each child using new and older drugs. There isn't one right medicine.
There are more than 20 medications used to treat seizures. Only some of these have been approved by the FDA for use in children. Legally, your doctor may prescribe any of the drugs. Still, it's important to be cautious about trying new adult epilepsy drugs in children until there's good evidence that they are safe in younger, small bodies. Discuss your child's options carefully with the doctor.
Types of Epilepsy Drugs
Common epilepsy drugs for partial or tonic-clonic seizures include brivaracetam (Briviact), carbamazepine (Carbatrol or Tegretol), phenytoin (Dilantin), valproate, and valproic acid (Depakote). Side effects can include stomach problems or tiredness, and in the case of Dilantin, excess hair growth. For absence seizures, medications include Depakote or Depakene and ethosuximide (Zarontin).
Some of the newer drugs used to treat various forms of epilepsy are felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Oxteller XR or Trileptal), tiagabine hydrochloride (Gabitril), topiramat (Topamax), or zonisamide (Lamictal or Zonegran). The FDA has also recently approved the drug Epidiolex, which is made from cannabidiol (CBD) and the medication fenfluramine (Fintepla) as a therapy for people with very severe or hard-to-treat seizures such as those from Dravet Syndrome.
The side effects for these epilepsy drugs vary, but generally, they include:
Less common side effects of epilepsy drugs include depression, irritability, hyperactivity, and increased risk of suicidal tendencies. Many epilepsy drugs cause specific side effects, and you should ask your child's doctor about them. Any side effects should be checked out with a doctor. This is especially true of rashes, which could indicate a possibly dangerous allergic reaction to the drug.
Rescue medications do not take the place of daily medications and should only be used to help stop a seizure quickly in emergency situations. Depending on the circumstance, they can be administered:
- Nasally - Sprayed up the nose
- Orally - Swallowed in pill form
- Sublingually - Placed under the tongue to dissolve
- Buccally - Placed between the cheek and the gum to dissolve
- Rectally - Given via a gel through the anus
The most commonly used medications are benzodiazepines because they get into the bloodstream quickly to start working on the brain to stop the seizure. They include:
- Diazepam - given orally (if the person is awake),
- Midazolam - can be given nasally (Nayzilam), buccally, orally
How much of a drug should your child take? There isn't a strict rule about this, and it varies with each child. Usually, doctors will try different epilepsy drugs at different doses to determine the best one for your child. Your child should take just enough medicine to prevent seizures without causing side effects. You and your child's doctor may need to tinker with the prescription over a few months to find the right dose. It's worth the effort. Too much medication increases the side effects, while too little leaves your child vulnerable to seizures.
Also, as your child grows, the doctor may adjust the dose of medication (blood levels sometimes help with this decision).
The Value of Epilepsy Drugs
You may be nervous about giving powerful epilepsy drugs, with all their possible side effects, to a small child. But drug treatments usually work, and stopping the seizures is crucial.
Still, you do need to take precautions to use these drugs safely. For instance, you have to be careful that the epilepsy medicine does not interact with another drug, supplement, or herb your child may take. Make sure to tell your doctor about all medications and supplements your child is using before you begin an anti-seizure medicine. It is also important to tell your doctor about any new medicines that are started after your child is on anti-seizure medicine.
Some parents worry that their children may later abuse drugs after taking epilepsy medicines during childhood. Rest assured: There is no evidence that children treated with epilepsy drugs are at higher risk for drug abuse.
Tips for Taking Epilepsy Drugs
For a child with epilepsy, sticking to a medication schedule can be tough. It can be hard for a child to remember to take medicine twice or even three times a day.
Here are some practical steps you can take to make it easier on your child:
- Buy a pill box for your child with spaces for each dose. You might also want to use alarms -- maybe on a wrist watch, cell phone, or computer -- to remind your child to take their medication.
- Talk to your child's teacher or the school nurse about how epilepsy medicines should be given at school. However, if possible, try to avoid giving medications at school.
- Talk to your doctor about simplifying the medication schedule as much as possible. If your child is supposed to take medicine more than once a day, or take multiple medicines, ask if there's any way to combine doses or switch to one drug.
- Set a sensible schedule. Sometimes parents continue the medication schedule that their child had in the hospital. This could involve waking up your child in the night to give medicine. Night-time medicine may not be necessary. Talk to your doctor about how to set the simplest and most sensible schedule.
- Don't run low on your medicine. Get in the habit of requesting drug refills several days before you'll run out of epilepsy medicine.
- Know what to do when your child misses a dose. Children inevitably miss a dose once in a while. Make sure you know what to do when it happens. Remember: Never double up a dose unless your doctor tells you to do so.
- Involve your child in the process. As the parent, you must make sure your child takes the epilepsy medicine. But it's a good idea to encourage your child to take some responsibility, too. Children with epilepsy will need to know how to follow their medication schedule on their own as they grow older.
- Be honest with the doctor. You may feel embarrassed to admit to your child's doctor that you've missed some doses. But even the most organized people forget sometimes. It's crucial that you honestly tell your child's doctor how often your child has really taken the epilepsy medicine. If your child takes medicine only half the scheduled times, the doctor may think the drug isn't working and raise the dosage. That can lead to side effects.
Remember, a person with epilepsy should never stop taking medicine without a doctor's consent. Stopping medication may lead to more, even stronger seizures.
When Epilepsy Drugs Don't Work
In most cases, epilepsy medicines will work. Be patient. Sometimes the drugs take weeks to take effect. Your child may start a new medicine and have a seizure a few weeks later. This doesn't always mean the drug isn't working. There may not be enough of the drug in your child's system yet to have an effect.
So while it may be painful for you, especially if your child is suffering seizures, don't jump the gun and abandon a medicine too early. Talk with your doctor and give it time to work.
After giving the medicine a fair shot and it still isn't working, then talk to your doctor about trying other drugs. If your child does not respond to the first two or three treatments for epilepsy, Turk, at the Nemours Children's Clinic, says you should visit a specialist who knows more about treating epilepsy in children.
"You don't have to accept epilepsy," Turk says. "You don't have to resign yourselves to years of seizures without other options."