Generally, epilepsy is successfully treated with antiepileptic medications. 60%-70% of people diagnosed with epilepsy will gain seizure control with medication. Others may continue to have seizures, but less frequently. When seizures continue to recur even with medication other treatment options such as surgery, stimulation of the vagus nerve, or, especially in children, the Ketogenic Diet may be considered. In the hope of seizure control complementary therapies are often explored. Any consideration given to complementary therapies should be thoroughly researched and discussed with your treating doctor.
Treatment is usually with antiepileptic drugs also referred to as AEDs. Many epilepsy syndromes respond well to a specific drug or to a combination of drugs. Drugs do not cure epilepsy but most seizures can be prevented by taking medication regularly one or more times a day. Optimally, the doctor and the patient will jointly make the decision about medication. Factors taken into consideration include:
- Type of seizure
- Likely risk of having other seizures
- Age of the person
- Gender of the person
- Persons general health
- Opinion of the person
Of people at risk of recurring seizures, more than 60% are likely to achieve complete seizure control with medication within a year. Commencing medication does not always mean that it must be taken for life. Regular medical reviews are recommended and many people need medication for a limited time, usually a few years. Do not suddenly stop taking medication as this can provoke seizures and possibly a medical emergency. Withdrawing from medication should always be carried out under medical supervision. Any changes to dose should be guided by the treating doctor.
Side effects & interactions
Seizure medication can interact with other medications including the contraceptive pill and some common over-the-counter treatments including herbal remedies. It's important for people to check for this when a doctor, pharmacist or other medical practitioner, suggests new medications. Any side effects that are thought to be a result of the medication should be discussed with your doctor or epilepsy counsellor. Sometimes the medication can be carefully switched to avoid unwanted side effects.
For many people, medication makes it possible to live normal, active lives free of seizures. Others may continue to have seizures, but less frequently.
Managing your medication
Some people are particularly sensitive to increased seizures when they miss a dose of their antiepileptic medication. The longer the break between doses, the lower your blood levels will go and the greater your chance of having a seizure. If you take your medication erratically or you suddenly stop taking all medication, you may trigger a severe and prolonged seizure or a cluster of seizures that will require hospitalisation.
Remembering to take medication regularly can be a problem. Many people with epilepsy experience difficulty with their short-term memory. Using a dosette box can help. It may also be helpful to carry a daily dose of your medication with you in case you are not at home in time to take the next dose.
The traditional advice on missing a dose has often been to simply pass on it and not to try to catch up. That is not always a good idea. Leading Sydney neurologist Ernie Somerville supports the current view that you should take the missed dose as soon as you realize it was missed, even if this isn’t until the next dose is due. That is, you should catch up. The risk of this is minor overdose, the symptoms of which are not serious and will last no more than a couple of hours, while the risk of not doing so is a seizure. Make sure you discuss this with your doctor. Better yet, make sure you don’t miss a dose. Some of the things you can do to remind yourself to take your medication is:
- To make it part of your daily routine take it with meals or take it when you get up and when you go to bed.
- Use a digital watch alarm to remind you when your medication is due.
It is more important to take your medication at a time when you are more likely to remember than at exactly 12 hourly [or 8 hourly] intervals.
Important information about AEDs:
- Seizure medication may be started slowly with the dose gradually increasing
- The treating doctor should guide changes to the type or dose of medication
- A new medication is often introduced while the old medication is reduced
- Sometimes a combination of medications is used
- Try not to miss a dose. Ask your doctor what to do if this happens
- A dosette box can help people to remember their medication
- If you are still having seizure while taking medication tell your doctor
- Plan ahead so you do not to run out of your medication
- Illness, diarrhoea and vomiting may affect the absorption of medication
- Seizure medication should not be stopped suddenly.
Generic medications & substitution
A generic drug is a drug based on a branded product but made by a different manufacturer. Research suggests that the minute difference between two versions of the same drug may cause problems for people with epilepsy if they are switched from one to another. While the chemicals used are exactly the same, there can be slight variations between the drugs due to the manufacturing process. For the vast majority of drugs this has little or no impact on the person taking the medication.
However due to the way antiepileptic drugs work even the slightest variation in the amount of the drug taken appears to cause problems for some people with epilepsy. Many generic formulations of some anti-epileptic medications are now available In Australia and it is now government policy for pharmacists to ask if a cheaper brand would be preferred.
It appears that any switch in medication whether it be branded to generic, generic to branded, or generic to generic may cause an increase in drug side effects, an increase in seizure frequency or breakthrough seizures in people whose seizures were previously well controlled.
People with epilepsy are advised to continue taking their prescribed medication. When a prescription is filled, check that the tablets are the same size, shape and colour, and the packaging carries the same name as prescribed by your doctor. If your pharmacist suggests that switching to another product can save you money politely refuse and insist on your usual medication. Switching drugs is not worth the risk.
Caution - Online pharmacies">
There has been an influx of online pharmacies offering discounted products by mail order. While this may be perfectly safe for ordering vitamins and other over-the-counter products, caution should be taken if considering ordering prescription medication this way. As it is Australian Government policy now to allow pharmacists to offer generic substitutions, you may have no control over the possible substitution of your prescribed medication and the inherent risks such substitution can have on your level of seizure control.
This fact sheet was written by Epilepsy Australia and appears on www.epilepsyaustralia.net.
Epilepsy Queensland is an affiliate of Epilepsy Australia and has permission to print this information.
Information reviewed by Dr. David Reutens, Brisbane.
Updated August 2013. To be reviewed 2015.
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