Epilepsy - Medications

Medications

Medicines to prevent epileptic seizures are called antiepileptics. The goal is to find an effective antiepileptic medicine that causes the fewest side effects.

Taking only one antiepileptic medicine prevents seizures in up to 7 out of 10 people with partial seizures. About 8 out of 10 people have complete seizure control when they take more than one antiepileptic medicine.¹ Although many people experience side effects, medicine is still the best way to prevent epileptic seizures. The benefits of treatment with medicine usually outweigh the drawbacks.

There are many antiepileptic medicines (called AEDs, anticonvulsants, or antiseizure medicines), but they do not all treat the same types of seizures. The first step your doctor takes in choosing a medicine to treat your seizures is to identify the types of seizures you have.

It may take time and careful, controlled adjustments by you and your doctor to find the combination, schedule, and dosing of medicine to best manage your epilepsy. The goal is to prevent seizures while causing as few unwanted side effects as possible. After you and your doctor figure out the most effective medicine program for you, it is important that you follow your program exactly as prescribed.

Using a single antiepileptic medicine is often better than using more than one medicine. Single medicine use causes fewer side effects and does not carry the risk of interacting with other medicines. The chances of missing a dose or taking it at the wrong time are also lower with just one medicine.

When treatment with one medicine does not work, adding a second medicine can sometimes improve seizure control. Also, if you have several types of seizures, you may need to take more than one medicine.

Medication Choices

Many medicines are used to treat epilepsy. Some are used alone, and some are used only along with other medicines. Your medicine options depend in part on what types of seizures you have.

Medicines that may be used first to treat epileptic seizures include:^{4, 5}

• Carbamazepine (Tegretol, Carbatrol).
• Ethosuximide (Zarontin), for absence seizures only.
• Topiramate (Topamax).
• Oxcarbazepine (Trileptal).
• Phenytoin (Dilantin, Phenytek) or fosphenytoin (Cerebyx).
• Valproic acid or divalproex sodium (Depakene, Depakote).
• Phenobarbital (Luminal Sodium, Solfoton). Phenobarbital is a first-line medicine for newborns.
• Primidone (Mysoline). The body converts primidone into phenobarbital.

If epileptic seizures continue even though you are being treated, your doctor may prescribe one or more of the following medicines:

• Felbamate (Felbatol)
• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Topiramate (Topamax)
• Zonisamide (Zonegran)
• Benzodiazepines (for example, Diastat, Tranxene, Valium)
• Phenobarbital (Luminal Sodium, Solfoton) (Phenobarbital is a first-line medicine for newborns.)
• Primidone (Mysoline). The body converts primidone into phenobarbital.
• Pregabalin (Lyrica). This medicine is intended to be used along with other antiseizure medicine.

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Taking your epilepsy medicine properly

Many of the first-line medicines control the same types of seizures equally well. Most antiepileptic medicines can cause nausea, dizziness, and sleepiness when you first start taking them, but these effects usually go away after your body adjusts to the medicine. Liver and blood problems are common to many of them. You may need to have regular blood tests to monitor for these side effects as long as you are taking the medicines.

Aside from these common problems, though, the medicines have different side effects, health risks, and costs. A medicine that works for someone else may not work for you.

When the more commonly used medicines fail to control seizures or cannot be used for some other reason, you may still have other medicine options.

• Many new investigational medicines are being developed and tested in clinical trials but are not in regular use yet. One of these might be an option. People with epilepsy who have not responded to standard therapy sometimes choose to participate in these trials. To learn more about clinical trials, talk to your doctor or visit the National Institutes of Health clinical trials Web site at www.ClinicalTrials.gov.
• There are also a few medicines that are only used for certain rare or severe forms of epilepsy in children. Children with infantile spasms, for instance, may respond to a corticosteroid (such as prednisone), adrenocorticotropic hormone (ACTH), or a medicine called vigabatrin, which has not yet been approved in the United States but has been approved in other countries.

What To Think About

All antiepileptic medicines have some unpleasant side effects. Ideally, medicine works to prevent seizures without causing intolerable side effects.

When choosing between medicines that treat the same type of seizure, you and your doctor will consider factors such as:

• How well the medicine works. The effectiveness of a medicine usually influences your willingness to take it.
• Possible side effects of each medicine.
• Long-term health risks of each medicine.
• How often each medicine has to be taken.
• Your age. Side effects may not affect children and adults in the same way. Medicines that can affect memory and thought processes may have a more severe impact on older adults.
• Your medical history and other health concerns that might affect the use of a medicine. For instance, many antiepileptic medicines can cause rare liver and blood problems and may be very risky if you already have liver disease or a blood disorder.
• The doctor's own experience in treating people with each medicine.
• The cost of each medicine.

Establishing a medicine routine that works can be difficult. Finding the correct dosage of a medicine may take months. Some people may have skin rashes, nausea, loss of coordination, and other short-term problems when they first start taking medicine for epilepsy. When the first medicine you try does not prevent seizures or you cannot tolerate its side effects, the doctor may have to start the process all over again with a different medicine. The chances of medicine therapy failure increase as the number of medicines tried increases.

If you or your child has epilepsy and needs to begin or change a medicine routine, talk to your doctor about what to expect from treatment with the medicine. You may or may not have a choice between medicines, depending on the types of seizures you or your child has and other factors. Thinking about and asking questions about antiepileptic medicines will help you prepare for the treatment.

Pregnancy raises special concerns for women taking antiepileptic medicines. Before you become pregnant, it is very important for you to talk to your doctor about how to handle your treatment.

You may consider stopping medicines if you have not had a seizure in several years. About 6 to 7 out of 10 people in this situation are able to stop taking antiepileptic medicines without having another seizure again for several years.³ But do not stop taking your medicine without first consulting your doctor.