7 Signs It's Time to Step Up Your Epilepsy Treatment

  • Time To Step It Up
    You’re having trouble with your treatment for your epilepsy. Maybe the medication you’re taking doesn’t seem to be quite right, or maybe you’re experiencing some troublesome side effects. Certain signs will let you know that it’s time to talk to your doctor about pursuing a different path of treatment.

  • 1. The first drug doesn’t work well enough.
    For many people with epilepsy, one anti-seizure medication works just fine. And that may have been you. But if you’ve gotten to the point where a particular anti-epileptic drug (AED) is no longer controlling your seizures—even at higher dosage levels—it may be time to find something more effective. About 20% of people with generalized epilepsy and 35% of people with partial epilepsy fall into this category. When the first drug doesn’t control the seizures, doctors will often substitute a different anticonvulsant medication from the first-line category that is suitable for your situation. Common first-line treatments for patients with partial seizures include carbamazepine, valproate and phenytoin. People with generalized epilepsy might take lamotrigine, valproate, phenobarbital, or phenytoin.

  • 2. The second drug doesn’t help enough, either.
    Trying a different first-line drug does the trick for many people. But for others, it’s just not enough. That’s when a doctor might try an add-on, or adjunctive, medication for people who experience partial, or focal, seizures. For example, depending on which first-line drug you’re taking, you might add on topiramate, levetiracetam, tiagabine, zonisamide or phenobarbital, among the possible options.

  • 3. An add-on drug doesn’t seem to be effective.
    Sometimes, these add-on medications do help, but sometimes they don’t. That’s when it’s time to investigate other options, including surgery or an implantable device. According to the Epilepsy Foundation, people should try at least two single drugs and a combination of at least two drugs without achieving successful management of their seizures before considering surgery.

  • 4. You have migraine headaches.
    About 12% of the population suffers from migraine headaches, and you may be one of them. If you do suffer the intense pain associated with migraines, ask your doctor about switching to an AED that can prevent your seizures and reduce the occurrence of migraines. Topiramate or valproate may be able to significantly reduce your migraines, although they can have side effects in high-doses. Gabapentin, divalproex sodium, and zonisamide are other anticonvulsives that are sometimes used to treat migraines, too.

  • 5. It’s hard to tolerate your medication’s side effects.
    Some people with epilepsy find that they can control their seizures with medication just fine, but they can’t tolerate the side effects very well. Depending on the drug, you might experience sleepiness or drowsiness, an upset stomach, nausea, fatigue, decreased appetite, or headaches, among other possible side effects. You might have a better experience with a different drug. But it’s worth making sure that you’re taking the medication correctly before you try switching to a different medication.

  • 6. You’re experiencing some of the most severe side effects.
    Nausea, headaches, fatigue and loss of appetite are annoying side effects, it’s true, but other side effects can be much more severe. Some rare but serious side effects of some AEDs include depression and suicidal thoughts. Don’t stop taking the drug on your own but definitely notify your doctor if you develop these symptoms so that you can investigate an alternate treatment. Some people also develop serious physical side effects, such as inflammation to their liver or pancreas.

  • 7. You withdrew treatment but your seizures have returned.
    Many people find that they can begin to taper down their medication and even withdraw from it after going two complete years without a seizure. It can take several months, as they gradually withdraw. If the seizures return, however, they’ll have to go back on medication and find a regimen that works. While anyone can experience recurrent seizures, it’s more likely for people with risk factors such as a history of intractable epilepsy or structural lesions in their brain.

7 Signs It's Time to Step Up Your Epilepsy Treatment
  1. Anticonvulsants – Antiepileptic Drugs. Migraine.com. https://migraine.com/migraine-treatment/anticonvulsants-and-antiepileptic-drugs/
  2. Anti-Seizure Medication and Their Side Effects. Epilepsy Foundation Western/Central Pennsylvania. http://www.efwp.org/programs/ProgramsSideEffects.xml
  3. Carroll E. Complex Partial Seizures. Medscape.  http://emedicine.medscape.com/article/1183962-overview
  4. Epilepsy Treatment. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/treatment/txc-20117241
  5. Goldenberg MM. Overview of Drugs Used For Epilepsy and Seizures: Etiology, Diagnosis, and Treatment. Pharmacy & Therapeutics. 2010 Jul; 35(7): 392–415. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912003/
  6. Ko DY. Epilepsy and Seizures Treatment & Management. Medscape. http://emedicine.medscape.com/article/1184846-treatment
  7. Kraemer DL. Epilepsy Surgery. Medscape. http://emedicine.medscape.com/article/251449-overview
  8. Migraine: Treatment and Drugs. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/treatment/con-20026358
  9. Epilepsy. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17636-what-is-epilepsy
  10. Preventive Treatments. Association of Migraine Disorders. http://www.migrainedisorders.org/managing-migraines/preventative-treatments
  11. Responsive Neurostimulation. Epilepsy Foundation. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/responsive-neurostimulation
  12. Side Effects: Seizure and Epilepsy Medication. Epilepsy Foundation. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/seizure-and-epilepsy-medicines/side-eff...
  13. Surgery: Treating Seizures and Epilepsy. Epilepsy Foundation. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/surgery
  14. Vagus Nerve Stimulation. Epilepsy Foundation. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns
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Last Review Date: 2018 Jun 21
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  • If your epilepsy treatment works just fine, there’s no reason to tinker with it. If it ain’t broke, don’t fix it, as the old wives’ tale goes. But if you’re having difficulty treating your epilepsy or are dissatisfied with the treatment, it may be time to consider switching to another one. For some, a new medication or set of medications may be just the ticket, while for others, surgery may be the best route.
  • If you’ve been diagnosed with epilepsy, you’re not alone. It’s the fourth most common neurological disorder in the United States. But not everyone with epilepsy experiences the same types of seizures or the same number of seizures. Over the years, researchers have tried to come up with ways of measuring how severe someone’s epilepsy is. For example, adults who are diagnosed with epilepsy may be measured with the Liverpool Seizure Severity Scale, but children may be assessed with information based on the Early Childhood Epilepsy Severity Scale (E-Chess). Regardless of the method or scale used, this information helps your neurologist plot the course of your treatment. But aside from the scales, what’s most important to you is how you understand your own epilepsy.
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