Your Seizure Medicines
Treatments are available that can successfully prevent seizures for most people with epilepsy. The first treatment is almost always one of the many seizure medicines that are now available. Each medicine tends to work better for certain kinds of seizures than for others. If one treatment fails, another may be more successful. This section provides in-depth information on epilepsy medications, investigational drugs and insurance issues.
Watch this introductory video on Antiepileptic Drugs (AED) presented by Dr. Fisher, MD, Professor of Neurology and Director of the Stanford Epilepsy Center
There is no known cure for epilepsy. But medications can control seizures in most people. These medicines do not actually "fix" the problems that cause seizures. Instead, they work by stopping the seizures from occurring. Before suggesting treatment with a seizure medicine (also called an antiepileptic drug or AED), your doctor usually has made a diagnosis of epilepsy. It is important to openly discuss with your doctor the pros and cons of the different medicines that are available to treat your kind of epilepsy.
How well do seizure medicines work?
Medicines can control seizures in most people, approximately 60 to 70% of people. However, a person’s response to medicine may vary. Research has shown that when people first start on seizure medicine, only 47% became seizure free with the first medicine. When a second drug was tried, another 13% of people became seizure free. When more than two drugs was tried the response to medicines decreased markedly; only another 4% of people became seizure free after the first two drugs. (1) This study, along with other research, stresses the need for people to seek help for their seizures early and if medicines aren’t working, to see a doctor who specializes in epilepsy. There are many different medicines for seizures and many of these can help, when given for the right type of seizures, at the right dose, and to the right person.
Seizure medicines do not actually "fix" the problems that cause seizures. Instead, they work by trying to stop or suppress the seizures. Before suggesting treatment with a seizure medicine (also called an antiepileptic drug or AED), your doctor usually has made a diagnosis of epilepsy. It is important to openly discuss with your doctor the pros and cons of the different medicines that are available to treat your kind of epilepsy.
How do seizure medicines work?
Many medicines act on brain cells to affect the way substances move in and out of the cells, or change the way substances called ‘neurotransmitters’ excite (e.g. stimulate) or inhibit (e.g. stop or slow down) the way information is sent from one cell and area of the brain to another. By changing the way brain cells work or send messages, medicines can affect and ideally stop the way seizure activity begins and spreads through the brain.
Scientists are constantly trying to find new ways that medicines could stop or control seizures. Some of the newer medicines work in a different way than the older medicines. It’s hoped that people who don’t respond to the older medicines may find a good response to a drug that works differently in the brain and may have different or less side effects.
What are the goals of treatment with medication?
The goal of treatment with medicines should be – “No Seizures and No Side Effects”. In reality though, it’s hard for many people to obtain this. They may get good control of their seizures, but have medicine side effects. Sometimes the side effects don’t bother people or are worth the benefits of not having seizures. Other times, the side effects aren’t manageable or cause other health problems.
In other people, seizure medicines help, but don’t make a person seizure free. Whether or not this is ‘good enough’ will depend on the type of seizures, other neurological problems, the way the person responds to the medicine, or side effects, for example. If the first drug helps some, but not enough, usually a second drug will be added. Ideally, a person can be kept on one drug to help lessen side effects, but some people may need two or more medicine to get the best seizure control they can.
How do I reach these goals?
While these goals cannot be achieved in everyone, improve your chances by following these steps:
1. Be open and honest with your doctor about your seizures and their impact on your life.
2. Be open and honest with your doctor about side effects and how they affect your health and daily life.
3. Follow instructions faithfully from your health care team. Do not stop taking any seizure medicine or change the amount you take unless the doctor tells you to do that. If you often forget to take your medicine, be honest with the doctor or nurse about that, too.
4. If you have a hard time talking with your doctor or other health care professionals, or are not satisfied with your care, talk to the doctor or health care professional first. Share your concerns and ask questions. If you can’t talk openly with your team, or you aren’t working towards the same goals, it may be time to get a second opinion.
When starting a new medicine, what questions should I ask?
When you are talking to your doctor about trying a new medicine, consider these questions.
1. How does this medicine work and is it different than the seizure medicines that you have tried before?
2. How helpful has the drug been in research studies? What is the likelihood that your seizure frequency may decrease by at least 50%? How about the chance for complete control of seizures?
3. Does the way the seizure medicine works mean that it may work better when given with some medicines than with others?
4. What are the side effects of the new medicine and what can you expect when it is added to your current medicines?
5. Does the new medicine interact with other medicines you may take for other conditions?
6. What is known about the use of the medicine during pregnancy or while breastfeeding?