Epilepsy is a brain disorder that causes repeated episodes of unprovoked seizures. There is no cure for epilepsy, but medications may help keep symptoms under control. Epilepsy is almost always treated first with medication.
Choosing the right one, however, can be challenging. There are at least 20 different drugs available to prevent seizures. Some have been around for decades. Many others have only been developed recently, and each drug comes with its own benefits and risks. Also, side effects and dosing schedules vary from drug to drug.
The ultimate goal of treatment is to establish control and be free from seizures. But sometimes, even after control has been established, people may still have a seizure, often referred to as a breakthrough seizure.
To help determine which medication you should try first, your doctor will carefully review your medical history and lifestyle. It's important to remember that epilepsy treatment is tailored to the individual. What works for you may not work for someone else. And some people may need to take more than one medication.
What Are Epilepsy Medications?
Your doctor or nurse may refer to epilepsy medications as antiepileptic drugs or AEDs. Other names used are anticonvulsants or antiseizure drugs. Sometimes, the drugs are just called seizure drugs. These medications help suppress the faulty signaling in the brain that leads to seizures. You must take epilepsy medication every day as directed, even when you aren't having symptoms. Some people need to take epilepsy medication for life.
The goals of using medications to treat epilepsy include:
- Having no or few seizures
- Having no or few side effects
- Using only one epilepsy medication, called monotherapy
Choosing the Right Epilepsy Medication
Which epilepsy medication is best for you depends on many factors, including:
Type of epilepsy. There are different forms of epilepsy, and each may cause a different type of seizure. It's very important that your doctor determine what type of epilepsy you have. Not all medications work on all types of seizures. And, sometimes, an epilepsy medication can make seizures worse. If your doctor can't determine what type of seizures you have, you may be prescribed what's known as a "broad-spectrum" epilepsy medication. Broad-spectrum means it can work on a wide range of seizures.
Other health issues and risks. You may have other medical conditions that dictate which epilepsy medications you can or cannot safely take. For example, liver and kidney disease may alter the levels of epilepsy medication in your bloodstream. Your doctor may also consider your risk of osteoporosis before prescribing an epilepsy drug. Some epilepsy drugs can cause bone loss and lead to osteoporosis. A vitamin D supplement may be needed. Menopause and other hormone changes can also affect the choice of epilepsy medication.
Pregnancy. You can have a normal pregnancy. Talk to your doctor before you try to get pregnant so that you can choose the safest medication for both seizure control and for your baby. Some epilepsy medicines can harm an unborn baby. For example, valproate is not recommended for women in their childbearing years. The medicine is known to interfere with the growth and development of a baby in the womb and has been linked to birth defects. Other drugs may also have some risk of birth defects. Having seizures while pregnant also poses serious risks, including miscarriage, trauma related to falling, and lack of oxygen to the fetus. Pregnancy itself can affect how your body breaks down an epilepsy drug. And that can put you at risk for breakthrough seizures or side effects. You may need to change your medication or adjust your dose. Never stop taking your medication without first talking to a doctor. During your pregnancy you will need to see a specialist to monitor your pregnancy and the health of your baby.
Other medicines you take. Some drugs can affect how an epilepsy medication works in your body and vice versa. Birth control pills, for instance, may not work as well if you take certain epilepsy medications. Always let your doctor know about all the medicines you take. That includes drugs, herbs, and supplements that you buy without a prescription.
What's most convenient for you. Most epilepsy medications are taken by mouth. Depending on the type of drug, you may have to take it several times a day. Talk to your doctor about when you will need to take the medication, and how this affects your lifestyle. In rare cases, epilepsy medicine may be given by injection. This is most often done when seizures need to be immediately controlled.
Side effects. Epilepsy medications can cause a variety of side effects, including fatigue, slowed or "foggy" thinking, unsteadiness, nausea, as well as skin reactions. There is also an increased risk of suicide and mood disorder among those with epilepsy. Older adults are often more sensitive to these side effects. Which side effects you can tolerate play a role in which drug your doctor prescribes. Your doctor will try to find a medicine that eliminates your seizures and has no side effects. However, this may not always be possible.
Cost. Cost may be a deciding factor when it comes to which epilepsy medication you choose. Older epilepsy drugs are often much less expensive than newer ones. Some brands are available in a cheaper, generic form.
The Epilepsy Foundation web site offers a complete list of available epilepsy medications and information about when the medicine is used, how it is taken, and the possible side effects.
Questions to Ask Your Doctor
Together, you and your doctor will decide which epilepsy medication might be best for you. Here are some questions to ask your doctor about epilepsy medication:
- How and when do I take this medicine?
- What side effects might it have?
- Will this medicine cause any long-term health risks?
- Can I safely take this drug with the other medications I take?
- I take birth control pills. Will this drug affect how they work?
- Can I take this drug if I get pregnant?
- What should I do if I miss a dose?
- How long do I have to wait to drive if you change my medication?
- Is there a generic I could take?
Remember, it is important to take your epilepsy medication exactly as directed. You need a consistent level of medicine in your blood to prevent seizures. If you miss a dose, stop taking the medication, or even change your medication, breakthrough seizures can occur. You will need regular blood tests to monitor the level of the epilepsy medicine in your bloodstream.
When Medication Does Not Work
Finding the best epilepsy medication for you can be complicated. Your doctor may need to change your medicine or dose from time to time to better control your seizures or reduce unpleasant side effects.
If medications do not control your seizures very well, your doctor may recommend surgery or an implanted device called a vagus nerve stimulator or a reactive neurostimulator. For children with epilepsy, the doctor may suggest a special diet.