Epilepsy Medication

Over the past 40 years new anti-epilepsy drugs have become available which enable about 75% of people with epilepsy to live seizure free.
Why are drugs prescribed?

 

The purpose of treatment is to control (not cure) epilepsy by getting rid of all seizures or at the very least by greatly reducing their number without producing undesirable drug side effects. Reaching this balance may take several weeks, months or even longer. During this period some people will experience adverse symptoms which can make them lose heart. In a few, control of seizures will never be fully gained, but it is most important to continue with the treatment and to keep a record of the number of seizures and any side effects experienced. This record will help the doctor to make the best decision if it becomes necessary either to change the dose of the medication being taken or to try another drug.

Are drugs the only treatment for epilepsy?

Anti-epilepsy drugs are the mainstay of treatment for epilepsy. Occasionally (for instance, in young children with very severe epilepsy) a special diet may be helpful. For a few people, surgery will be advised.

What are the most common anti-epilepsy drugs?

There are several different drugs which are commonly prescribed. These may be referred to by the chemical name of the drug or by the trade name (in brackets) given to the drug by the manufacturer.

• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal)
• Vigabatrin (Sabril)
• Gabapentin (Neurontin)
• Clobazam (Frisium)
• Clonazepam (Rivotril)
• Ethosuximide (Zarontin)
• Phenytoin (Dilantin)
• Primidone (Mysoline)
• Sodium Valproate (Epilim)
• Topiramate (Topamax)
• Tiagabine (Gabitril)
• Levetiracetam (Keppra)

How do these drugs work?

Anti-epilepsy drugs are absorbed into the blood system and carried in the blood to the brain to damp down the “electrical storms” which cause seizures. Seizure control is helped by maintaining a roughly constant amount of the drug in the bloodstream throughout the day and night. Missed doses reduce the blood level and can result in more seizures. Too much medication can surprisingly, sometimes also cause an increase in seizures. It is important, therefore that the same amount of drug is taken each day. If a tablet is forgotten it should be taken immediately it is remembered and the next dose should be taken at the usual time. This may make people feel a little dopey for a while but will help to prevent a seizure occurring. Extra medication should not be taken after a seizure. Anyone having a lot of seizures, should consult their doctor, who may adjust the dose of the anti–epilepsy drug.

Do anti–epilepsy drugs have side effects?

Anti–epilepsy drugs are not addictive but they sometimes cause side effects. These can include drowsiness, weight gain, temporary hair loss, skin rash, swollen gums, unsteadiness and stomach upsets. These adverse effects can often be minimised. Good dental hygiene can prevent swollen gums. Correct timing of doses can ensure that any drowsiness occurs only at night. Taking the medication with food can abolish stomach upsets. Watching diet will help to prevent a gain in weight. The appearance of a skin rash should be reported immediately to a doctor. The benefits of good seizure control must be balanced by the disadvantages of side effects when deciding the correct drug and dose.

 

Women who take anti–epilepsy medication and wish to use some form of oral contraception should seek medical advice as most anti-epilepsy drugs can reduce the effectiveness of the contraceptive pill.

 

It is most important that women on anti–epilepsy medication who want to have a baby consult with their doctor before becoming pregnant as there may be a small risk to the baby from the anti–epilepsy drug treatment. Changing or reducing the anti–epilepsy drugs may be advised. A woman who is already pregnant should discuss with her doctor the best course of action to minimise risks to herself and to her baby. It is important to minimise the number of seizures during pregnancy to avoid harm to the unborn child.

Why is a particular drug chosen?

Drugs for epilepsy come in many different forms – tablets, coated pills, capsules, syrups and liquids. There are many factors which can influence the doctor’s choice. The type of epilepsy, medical history and any other medication taken must all be considered.

 

The doctor must also decide which form of the drug is most suitable for each patient to take. Syrups may be used for children who have difficulty in swallowing tablets. Changes in the make of the usual tablet or capsule should be avoided as the amount of drug absorbed from each different kind of pill can vary a little.

 

What is the right amount of anti–epilepsy drug to take?

 

The most effective amount for controlling seizures varies from person to person. However, the correct dose of the right drug (or in a few cases, the right combination of two drugs) will control seizures in more that 75% of people with epilepsy. As children grow, their dose may need to be increased. A bigger dose may also be advised if seizures are not fully controlled. Consult a doctor if seizure control is unexpectedly poor, or if side effects become a problem and explore whether measuring the drug level in the blood might be helpful.

How often should the drug level be measured?

The frequency with which these tests should be carried out depends on which drug is being taken, how effective it is and whether there are side effects. The person’s medical history and the number of other drugs being taken are also relevant factors. Because some people metabolise anti–epilepsy drugs more quickly than others, regular blood tests may be recommended to ensure that the best dose is being prescribed. By using a few drops of blood, tests (such as enzyme immunoassay) can reveal quickly whether the dose is too low to be effective, or too high and likely to cause unpleasant side effects. If seizures are fully controlled without any side effects whatsoever, it is usually not necessary to measure the drug level. More frequent measurements may be necessary during pregnancy or while breastfeeding.

How can missed doses be avoided?

The importance of taking drugs at intervals cannot be overemphasised. However it is not easy for everyone to remember to take the correct dose at the same time each day, particularly if he or she has a poor memory. The answer may be to set aside the doses each morning so that a check can be made in the evening that the full amount has been taken. Containers with the daily dosage helps people to take their medicine in the correct dose and at the right time. The container is divided into 7 sections – one for every day of the week. Each section is divided into 4 compartments allowing up to 4 daily doses to be held. An alarm wrist watch can also be used to remind a person when to take medication. If a dose is missed, it should be taken as soon as it is remembered. If medication has been missed it is very unwise to take part in potentially dangerous activities such as driving or swimming.

 

If occasional nights are spent away from home, missed doses can be avoided by always carrying a spare dose to cover unexpected circumstances. When holidaying abroad it is important to take a supply sufficient to cover the period away from home, as it may not always be possible to get the same tablets or capsules in a foreign country. Anti-epilepsy medication is sold under different trade names in other countries and so when travelling abroad people may find it difficult to identify the drug they have been prescribed.

For how long will medication be necessary?

There is no easy answer to this question! It will depend on the individual case of epilepsy. Some people will need to be on medication throughout their life. However, it may be possible for a person who has been free of seizures for more than two years to have medication slowly withdrawn under medical supervision. Some doctors (and patients) prefer to wait for 5 years. It is important that medication is never altered or stopped except by a doctor. The danger of changing a drug regime without medical advice is that it may lead to prolonged or repeated seizures which can prove dangerous.

What other precautions need to be taken?

Most children like to mimic the activities of adults and they may be tempted to copy a parent who takes tablets every day. It is very important that all medication is kept out of the reach of children.

 

Alcohol interferes with the effectiveness of anti-epilepsy drugs and so it is advisable to avoid alcohol altogether or consume it only in modest amounts.
Avoid carrying tablets in glass bottles as these may break during a seizure. Most chemists now supply plastic bottles.

 

However frustrating it may be to take medication over a long period, it is important to comply with the prescribed drug treatment if seizures are to be fully controlled.

Hope for the future!

Advances in the understanding of the neurochemical basis of epilepsy and research into the development of new anti–epilepsy drugs will contribute in future to better seizure control for even more people with epilepsy.

 

Original courtesy of Epilepsy Association of Scotland – Reviewed June 2021

Generic Alternatives

Recently, some epilepsy medications have become available in generic form. While generic form has the same active ingredients as the branded one, Epilepsy Australia Ltd does not recommend that you switch from one to another. For some people, switching has resulted in breakthrough seizures, increased seizures, or new side effects. We suggest that, unless you obtain approval from your doctor, you would be best advised to continue taking the branded medication/s prescribed by your treating doctor.