How is Epilepsy Treated?
Epilepsy may be treated in three ways: prescription drugs, a special diet regimen, or surgery. Treatment must be tailored specifically for each individual patient in order to be most effective. Even patients with the same type of epileptic seizures may require different methods of treatment. There are pros and cons associated with each method of treatment.
Medication:
A number of medications are currently used in the treatment of epilepsy. These medications control different types of seizures. People who have more than one type of seizure may have to take more than one kind of drug (polytherapy). However, like any other treatment for disorder, doctors try to control the symptoms with one drug if possible (monotherapy).
Drugs prescribed to prevent epileptic seizures are referred to as antiepileptic drugs (AEDs). (Antiepileptic drugs are also commonly categorised as anticonvulsant drugs, however not all epileptic seizures induce convulsions in patients, and not all seizures are caused by epilepsy.) The antiepileptic (seizure-preventing) drug will not work properly until it reaches a certain level in the body (blood concentration) and that level has been maintained. It is important to follow the doctor’s instructions very carefully as to when and how much medication should be taken.
The goal is to keep the blood level high enough to prevent seizures, but not so high that it causes excessive sleepiness or other unpleasant side effects.
What Kind of Medications Are Used to Treat Epilepsy?
Modern science has greatly improved antiepileptic (anticonvulsant) drugs, which have dramatically changed the lives of people with epilepsy. And though none of the existing drugs can cure epilepsy, if a carefully prescribed and well-followed regimen of medication is respected, it has been found there has been an increase in control and prevention of seizures, and in many cases, a complete elimination of seizures altogether.
Whenever possible, physicians use monotherapy, the use of a single drug, to control seizures. The more drugs used, the greater the chance of drug interactions and side effects. However, sometimes seizures are more difficult to control and you may have to take more than one medication. Even though the obligation to follow a strict course of anticonvulsant therapy can be frustrating, the right medication can greatly improve your ability to lead a full and active life.
Reaction to a given drug varies from person to person. Medication that works for one person with epilepsy will not necessarily work for another. Of two people taking the same drug, one may experience side effects while the other will not. By the same token, some drugs will reach a therapeutic, seizure-preventing level in a patient's bloodstream more quickly than other drugs.
For these reasons, it may take some time to customise the dosage and/or choice of drug(s).
Doctors try to achieve a balance by prescribing the medication that offers the greatest degree of seizure control with the fewest side effects.
Drugs & Compliance
Your drug therapy requires your active participation. If you have confidence that you are being properly treated, it will contribute to better emotional well-being and you may even have fewer stress-related seizures. It is important that you trust your doctor and communicate clearly with him or her.
Here are some important points to remember if you take antiepileptic (anticonvulsant) medication:
Follow your prescription:
- Take the prescribed medication. Too little medication can lead to a seizure.
- Never stop taking medication abruptly. If you do, you may run the risk of life-threatening non-stop seizures.
- Don't take other people's pills. The medication that works well for a friend may not work for you.
Be careful with alcohol:
- Avoid drinking alcohol or taking street drugs with your medication.
- Alcohol can interfere with AED drugs and can prevent them from reaching therapeutic blood levels.
- Many AEDs cause sedation or sleepiness and may lower a person's tolerance to alcohol. At the same time, be sure not to miss your medication simply because of moderate use of alcohol.
Coping with the AEDs:
- Find out how a new medication affects you before driving.
- You may be able to function perfectly, but the drug may make you drowsy, something you will need to know before attempting to drive.
What happens when you miss a dose?:
- Medication has to be taken at regular intervals. Consult your physician if you miss a dose. Don't assume that you can make up for a few missed doses by taking them all at once.
- Inform your physician if you've been missing doses and having more seizures as a result. Otherwise, he or she may assume that your dosage is too low, decide to increase it, and you may find yourself over medicated.
Other handy tips to help adjusting to taking medication regularly:
- Use special containers, available at drugstores, to count out a day's supply of pills if you have trouble remembering how to take your medication in sequence. This suggestion applies to people who must take more than one type of anticonvulsant drug.
- Don't run out of medication. Set up a reordering schedule that makes the procedure automatic. Similarly, if you are going to be out-of-town, be sure to take along enough medication to last until your return. You should also carry a copy of your prescription with you.
Storage:
- Keep all medication locked up and away from children. If you plan to carry medication in a container other than a drugstore bottle, make sure that the container bears your prescription label. In some places, it is actually illegal to carry medication in anything other than its original container.
- Proper storage of medication is important. Medications kept outside the recommended temperature range may start to break down or react differently with their environment. To ensure this does not happen, make sure you read the bottle carefully and follow the storage recommendations. If you are unsure, ask your pharmacist or doctor how you should best store your medication.
Antiepileptic (anticonvulsant) drugs can successfully prevent seizures for most people with epilepsy who take them regularly and as prescribed.
Drug Side Effects & What to Look For
The newer, anticonvulsant drugs are generally very safe, but side effects can, and do, occur. Their degree of severity depends on the kind of medication being taken, the dosage, and the individual response of a patient to the medication. Minor side effects are common at the start of drug therapy but an allergic reaction in the form of a rash is a severe, adverse condition that necessitates an immediate change to another medication. A physician should be notified immediately.
The most frequently reported side effects of AEDs are drowsiness, irritability, nausea, skin rash, lack of physical co-ordination and, in children, hyperactivity. Emotional changes may also occur. Occasionally, a drug will actually increase, rather than decrease, the number of seizures a person experiences.
In addition, particular care must be taken when a drug shows signs of affecting blood cells. Instances of fever, sore throat, mouth ulcers, easy bruising, pinpoint bleeding under the skin, or any other change in physical wellbeing, should be reported immediately.
If you are planning on becoming or are pregnant, advise your physician immediately so he/she can factor that in the decision of which AED to prescribe. Some medications are harmful to the developing fetus. This is important for both your health and the health of the baby.
Why is it Important to Monitor Blood Levels?
Antiepileptic drug-level testing helps a physician achieve seizure control by monitoring the presence of a medication in a patient's bloodstream. The bloodstream is the pathway to the brain and, therefore, leads medication to the centres of the brain in which seizures begin. If a drug's blood level concentration is too low, seizures may occur and the dosage will have to be increased. Conversely, too high a drug level may cause a patient to experience side effects, such as drowsiness or confusion. This necessitates a reduction in dosage or, possibly, a change to a different medication.
Generally, drug testing should be performed during the course of treatment, and again when good seizure control has been established. Subsequent tests may be carried out if there are changes in control, or if side effects occur.