What If My Epilepsy Treatment Doesn’t Work?

Studies show that nearly 40% of people with epilepsy don’t respond to the first, or even the second medication they take to treat their symptoms.

Everyone with epilepsy responds differently to treatment. It can take some trial and error before your doctor finds the right one for you and your symptoms.

Your doctor will probably begin with one low-dose medication. Then, depending on how you respond, she may increase your dosage slowly. You may also need a combination of meds to control your seizures.

Why It Isn't Working

The success of your treatment can depend on a bunch of things, including:

How quickly you begin your treatment. Studies show if you’ve had untreated seizures for a while, medicine may not work as well to control them.

The right diagnosis. Epilepsy comes in many forms. The type you have determines which medications you should take. For example, you could have non-epileptic seizures you thought were epilepsy. These kinds of seizures won’t respond to epilepsy meds.

Your lifestyle. Your doctor may ask you to keep a record of your seizures and other details of your day. She does this so she can look for things that might be affecting your condition. She may ask you to track things like your:

  • Diet
  • Sleep patterns
  • Exercise habits
  • Side effects
  • Stressors
  • Signs of illness of infection

Other medications. Some meds can interact with what you take for epilepsy. That can keep them from doing what they should.

Before they make any changes, your doctor probably will want to take a close look at some things that could affect your treatment. They may ask questions like:

  • Are you taking your medications exactly how your prescription says?
  • Did you switch to a generic version?
  • Are you taking any herbal remedies along with your treatment?
  • Did you stop taking your medication at any point?
  • Have you been sick lately?
  • Are you abusing drugs?
  • Do you have any major stress in your life right now?

Your answers can help your doctor figure out if your meds aren't working, or if you need to make other changes that could help them work better.

If your doctor wants you to switch, it’s likely you’ll keep taking your original meds as you start the new one. Once the new one is at a certain level, you’ll take lower and lower doses of the first until you can stop taking it completely.

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When Medications Don’t Work

If you’ve tried a lot of different medications and are still having seizures, your doctor may send you to an epilepsy specialist. Depending on the treatments you’ve already tried, and the type of epilepsy you have, a specialist may recommend one of these:

Ketogenic diet: This is a special high-fat, low-carb plan that makes your body break down fat instead of carbohydrates for energy. Doctors sometimes recommend this for children who don’t respond to medications. You should only try a ketogenic diet if a doctor tells you to and is watching your health while you're on it.

Vagus nerve stimulator: This is a special device that a doctor surgically implants under your skin. It sends bursts of electricity to your brain through your vagus nerve. Doctors sometimes recommend this when medication isn’t working and surgery isn’t an option.

Neuropace device: This is a reactive neurostimulator that detects seizures and shocks the brain to stop them

Epilepsy Monitoring Unit: Your doctor may admit you into an EMU whereyou would be put on continuous EEG and your medications stopped to try and capture a seizure. your doctor could then determine where they come from and if they are electrographic/epeleptic or nonepileptic. 

Surgery. Typically, doctors suggest an operation only after you’ve tried two or more medications, or if you have specific spot in your brain where the seizures start so that spot can be removed.

There are several surgery options, including:

  • Removing a small part of your brain (lobectomy or lesionectomy)
  • Making small cuts in your brain (multiple subpial transection)
  • Cutting the connection between the two sides of your brain (corpus callosotomy)
  • Removing half of your brain’s outer layer (hemispherectomy or hemispherotomy)

Even if surgery stops your seizures, your doctor will likely keep you on medication for a couple of years.

WebMD Medical Reference Reviewed by Christopher Melinosky on July 24, 2019

Sources

SOURCES:

Epilepsy Foundation: “If First Medicine Doesn’t Work,” “Types of Epilepsy Syndromes.”

Mayo Clinic: “Epilepsy.”

National Institute of Neurological Disorders and Stroke: “The Epilepsies and Seizures: Hope Through Research.”

Epilepsy Society: “When AEDs Don’t Work.”

American Epilepsy Society: “Facts and Figures.”

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