There is a wide number of drugs available for treating epilepsy in children, and advances in the past years have made a difference. In fact, nine new medications have become available in the last decade.
But that doesn't mean the newest drug for epilepsy is the best. New drugs have helped, but 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.
Only some of the 20 or so medications used to treat seizures 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 in 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 drugs for partial or tonic-clonic seizures include carbamazepine (Carbatrol or Tegretol), phenytoin (Dilantin), and valproate, valproic acid (Depakene, 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 other drugs used to treat various forms of epilepsy are ACTH (Acthar gel), clobazam (Onfi), diazepam nasal spray (Valtoco, Neurelis),felbamate (Felbatol), gabapentin (Neurontin), lacosamide (Vimpat), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Oxteller XR or Trileptal), phenobarbital, tiagabine hydrochloride (Gabitril), topiramate (Topamax), vigabatrin (Sabril), and zonisamide ( Zonegran). The medications diastat rectal gel, Epidiolex (made from cannabidiol or CBD), fenfluramine (Fintepla) have both been approved Dravet Syndrome.
Some of the anti-seizure medications -- like Depakote -- have been approved as monotherapy for children. This means that it could be the only epilepsy drug your child would take. Many children prefer monotherapy because they only have to remember to take one pill. Some of these have sprinkle forms to add to food to make it easier to take.
The side effects for these epilepsy medicines vary, but generally, they include:
Less common side effects of epilepsy drugs include depression, irritability, and hyperactivity. 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 drugs 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:
- First, keep all medicines, especially seizure medicines, away from young children. An overdose of these medicines can be especially dangerous.
- 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 phones, or computer -- to remind your child to take their medication.
- Talk to your child's teacher or the school nurse about how epilepsy drugs 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. Nighttime 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 drugs will work. Be patient. Sometimes, the drugs take weeks to take effect. Your child may start a new drug 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. Ask your doctor if a seizure action plan is right for your child.
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, visit a specialist who knows more about treating epilepsy in children. They may suggest other hterapies including a ketogenic diet or surgery.