Treatment of epilepsy with medications

Did you know?

The first treatment prescribed will usually ensure satisfactory control of seizures for most epileptics.

The objective of treating epilepsy in children, adolescents and adults is to achieve an absence of seizures without adverse effects, and to attain the best possible quality of life. The majority of epileptics are treated with anti-epileptic medicines that help to restore the electrical balance of the brain. Such medicines reduce the sensitivity of neurons, thus helping to reduce the number of seizures or even to stop them.

How to select a medication

The choice of medication is not a random decision. Medication must be selected for each patient individually according to:

  • type of seizure,
  • age of the person,
  • likelihood of significant adverse reactions.

The treatment of epilepsy is not easy. Despite the wide range of medications available to children and adults with epilepsy, it is still not possible to achieve the ultimate goal, which is the complete prevention of seizures. A neurologist, paediatric neurologist, or a paediatrician with additional training can best choose the right medication and determine an appropriate dosage. It is important to take the medicine exactly as prescribed by the specialist, because this is the only way to achieve control of the seizures. Medication completely stops the occurrence of seizures in about 5 out of 10 children and adults, but this can only result from treatment with the most appropriate medication for the individual and at the correct dosage. For the majority of epilepsy cases that develop during childhood or adolescence, the outlook is excellent. It is very likely that such children may at sometime live without anti-epileptic medication.

Anti-epileptic medication

Anti-epileptic medicines cannot cure epilepsy, but they do help to control seizures. Normally, anti-epileptic medicines should be taken twice a day, usually during meals (before or during a meal or after a meal). The medicine should be taken at the same time each day. The medicines reduce the excitation of neurons, thereby reducing the probability of seizure. In order for the medications to be effective, a constant blood concentration in the body should be maintained, which is why it is so important that the patient takes them regularly. Your doctor will usually advise a slow start of treatment with a steady increase of dosage. This way the body has time to become used to the medicine, and adverse effects are reduced. Should side effects occur, your doctor may first reduce the dosage and then increase it slowly to an effective measure. If seizures continue to occur or if the side effects worsen, your doctor may choose a substitute medication. The first treatment prescribed will usually ensure satisfactory control of seizures for most epileptics. Patients who do not tolerate the treatment well or still experience a lot of seizures may need a different medicine. Your doctor will advise you whether this is necessary for you or your child.

Adverse effects

Any kind of medication, not only anti-epileptics, may cause side effects. It is important to monitor the number of seizures (per day, per month, per year) and the general state of well-being during the treatment in order to enable your doctor to help with a choice of medicine that will be as suitable as possible for the patient. Many people embrace side effects as part of treatment. But it does not have to be that way. If a patient reports adverse reactions, the neurologist may decide to reduce the dosage or substitute the medication for one that may be easier to tolerate.

Some side effects of anti-epileptic medication occur upon initiating the treatment, while the body is still getting used to it. As you continue the treatment, the intensity of side effects may be reduced or  vanish completely. Adverse effects may be the following:

  • drowsiness, fatigue,
  • vertigo, dizziness,
  • irritability, hypersensitivity,
  • allergic reactions, skin rash.

Severe reactions may occur with prolonged administration of a particular medicine. Some examples:

  • poor memory and concentration,
  • slow speech, difficulty finding words,
  • swollen gums,
  • acne,
  • change of body weight,
  • excessive hair loss or thinning/thickening of hair on unusual parts of the body.

In some cases, idiosyncratic effects may occur. Such effects are dose-independent and result from an allergic reaction to the medication. There is a certain degree of danger to them and they usually do not stop when the medication is discontinued. Idiosyncratic side effects often manifest in the form of rash, itching, or even fever and uncharacteristic poor well-being. In recent years, a number of new anti-epileptic medications have been launched which are available in various forms. Some of these have fewer side effects compared to older anti-epileptics.