6 Reasons Why Your Epilepsy Treatment May Not Be Working

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If you have epilepsy, it’s likely your doctor prescribed a few different medications at various dosages before you found the one that helped control your seizures best. But over time, your epilepsy treatment may not work as well as it once did. Although this can be discouraging, before worrying that you may have to start over again, there could be a simple fix, depending on why the treatment stopped being effective. Here are some things to watch out for if your epilepsy treatment doesn’t seem to be working.

1. You may be taking your medicine at the wrong time.

Drugs that control seizures are very precise. In order for these drugs to be most effective, they must be taken exactly as prescribed. There needs to be a certain level of the medication in your body at all times, which means you must take the correct dose every day, at the same time of the day. If you forget to take your pill or you’re delayed and you take it later than usual, the therapeutic (effective) level will drop and you may have a seizure.

Of course, life can get in the way sometimes and you may be late taking your medication every now and then. Speak with your pharmacist or neurologist beforehand, so they can advise you what to do if this does happen.

2. You’re not following instructions.

Many medicines need to be taken a specific way to be effective. For example, some drugs shouldn’t be taken with foods, and some specifically not with dairy products. Medicines that come in tablets or capsules may have a warning to not chew or break them. If your epilepsy medicine comes with a warning about how you should take it, it’s vital that you follow those instructions.

For example, phenytoin (Dilantin) and several other epilepsy drugs come with a warning to avoid alcohol. If you drink alcohol while taking phenytoin, the drug itself may become less effective, putting you at risk for having a seizure. If you’re not certain about your medicines and what you can and can’t do while taking them, speak with your pharmacist, who can tell you more about your prescription.

3. Different brands may have different effects.

By law, generic and brand names of the same drugs must contain identical medicinal (active) ingredients, so as a rule they are each as effective as the other. That being said, the medications are slightly different in other ways. They may include a different binding agent (what holds the pills together) or dye for coloring, for example. For the most part, this doesn’t cause problems, but with epilepsy medications, it could. Your body may get used to one manufacturer’s version of your drug and if you switch to a different manufacturer, the slight difference may be just enough that it won’t be as effective for you. Some people who take anti-seizure medications always take generic ones, but from the same company. Others take only the brand names. You can ask your neurologist to specify yours on your prescription.  

4. Your epilepsy drug dose isn’t high enough.

Our body changes as we get older and as we go through different phases of life, such as puberty, pregnancy, stresses, illness, and injury. These changes can affect how we react to certain medications. If your epilepsy drug is no longer keeping your seizures under control, it could be because of body changes, and your neurologist may need to change your dose.

5. Something is counter-acting your medicine.

How well a medicine works can be affected by other drugs, herbs, supplements, and foods. For example, vitamin D and calcium supplements may affect the effectiveness of phenytoin, as can alcohol. Certain antibiotics, such as doxycycline, can lessen the effects of carbamazepine (Tegretol), putting you at risk for seizures. Always tell your neurologist about all other medications and supplements you are taking, even if they seem harmless. And if you want to take an over-the-counter drug or a supplement, speak with your pharmacist who can check to make sure that the product is safe to take with your medications.

6. Your type of epilepsy doesn’t respond to medication.

Some types of epilepsy are refractory or intractable, which means they don’t respond to the regular epilepsy medicines. If you are taking these medications and your seizures are not controlled you may need a different type of treatment.

If your seizures are not being controlled by your medication, a little bit of detective work may be needed to figure out why. By speaking with your pharmacist or neurologist, you might learn that the solution may be as simple as changing brands or sticking to a stricter schedule.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Jun 15
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