Medical Management of Epilepsy

Was this helpful?

Medications are almost always the first-line treatment for epilepsy. Doctors use them first because they control seizures in 70% of people with epilepsy. These anti-seizure drugs can’t cure the condition, but they can stop seizures from occurring. And some work better for certain kinds of seizures than others. Here’s what you need to know.

The goal is to have no seizures and no side effects.

The goal of using medicines to treat epilepsy is to stop seizures without experiencing side effects. This can be a challenge. All medicines have the potential to cause side effects. And it can take time to find the right drug and right dose to control your seizures. The good news is there are many anti-seizure medicines and if one doesn’t work, another might. And if you can’t tolerate the side effects of one, you may find better results with a different one.

You can give yourself the best chance of finding a medicine that works by seeking the right help. Research suggests people who get help early with their seizures tend to do better. It’s also important to find a doctor who specializes in treating epilepsy, such as a neurologist.

Anti-seizure medicines work by changing electrical activity in the brain.

The way anti-seizure medicines work is complex. Even the experts don’t fully understand how some of them work. Epilepsy medications essentially change the electrical activity in the brain that causes the seizures. But each does this in different ways. Some affect the way chemicals called neurotransmitters send messages in the brain. Others attach to brain cells and change the way ions move in and out of them. Ions affect the way electrical activity travels down a brain cell. And other medications work in both ways.

Many people find success with epilepsy medications.

About half of people will get their seizures under control with their first medicine. Choosing this first medicine depends on the type of seizures you have. Your doctor will also consider side effects, drug interactions, and your other health conditions.

Common examples of anti-seizure medicines include:

·       Benzodiazepines such as clonazepam (Klonopin)

·       Carbamazepine (Tegretol)

·       Divalproex sodium (Depakote) and valproic acid (Depakene)

·       Gabapentin (Neurontin)

·       Lacosamide (Vimpat)

·       Lamotrigine (Lamictal)

·       Levetiracetam (Keppra)

·       Phenytoin (Dilantin)

·       Pregabalin (Lyrica)

·       Tiagabine hydrochloride (Gabitril)

·       Topiramate (Topamax)

It can take some time to find the right dose for you, and you may need to switch medicines or add one. It generally takes a few months to know if a medicine is working. Knowing this ahead of time can take some of the frustration out of the process.

Taking your medicine regularly is key for controlling seizures.

Healthcare providers have a name for taking your medicines the right way, at the right time, each and every day: adherence or compliance. It gives you the best chance of controlling your seizures. Missing or delaying doses can cause the medicine to fail at preventing seizures.

Sticking with your medicine regimen may not always be easy. Different drugs need to be taken at different times and may have varying food requirements. You’ll need to take some on an empty stomach, while for others it doesn’t matter. Get help from the members of your healthcare team. Nurses and pharmacists are great resources for help managing your medicines.

Some people can eventually stop their medicines.

If your seizures are well controlled, it’s common to want to stop your medicines. This may be possible for some people. Generally, your doctor will consider the following:

·       You have been seizure-free for 2 to 4 years.

·       Your seizures responded well to one medicine.

·       Your physical exam and tests—such as EEG—are normal.

Even if you meet these criteria, there are no guarantees. You could still have another seizure if you stop your medicine. And your doctor can’t predict if or when it could happen. So take your time making this decision and talk often with your doctor. And never stop taking your anti-seizure medicine without your doctor’s consent.

Was this helpful?
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Dec 4
Explore Epilepsy
  • Learn how epilepsy and seizure symptoms can affect driving, and how epilepsy driving laws may affect you.
    August 17, 2018
  • One in 26 Americans will develop epilepsy during their lifetime and caregiving for this disorder can be scary and stressful. Seizures happen unexpectedly and not knowing how to respond can be a big challenge for caregivers. Though epilepsy presents itself in different ways for every person, there are general guidelines that can make you feel more capable and prepared as a caregiver.
    June 10, 2016
  • 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.
    June 10, 2016
  • These basic first aid steps will help you protect and care for your loved one during a seizure.
    June 10, 2016
Recommended Reading
Next Up
  • One of the most widely known epilepsy seizure triggers is flashing lights.
  • Doctors use a variety of tests and your own symptom history to confirm a diagnosis of epilepsy.
  • The symptom that defines epilepsy is recurrent seizures, which are caused by abnormal electrical activity in the brain.
  • While there is no cure for epilepsy, it is possible to control the symptoms with medications, surgery or electrical stimulation.
  • Epilepsy can result from any type of damage to the brain, though in some cases the cause is not known.
  • Epilepsy is a condition in which there is disordered electrical activity in the brain resulting in seizures.
  • 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.
Answers to Your Health Questions
Trending Videos