Medical Management

Epilepsy today is largely treated with medication. However, these do not cure epilepsy they provide control of seizures only.

Antiepileptic drugs (AED’s) can successfully control up to 70-80% of epileptic seizures. They come in the form of tablets, capsules or syrup.

The first medication that is tried is not always the right one. Many people need to trial more than one medication before they obtain seizure control.

Most people with epilepsy get best control with only one drug; some people may need a second drug to be added. Choice will depend on factors like seizure type, age, lifestyle, employment and side effects.

The doctor will give you instructions on how and when to take the medication and what unwanted effects may occur.

General guidelines:

Read the manufacturer's instructions and information.

Take your medication as prescribed. Altering dosage or daily routine may provoke unexpected seizures or side effects.

When medication is prescribed ask your doctor:

• What other medicines may interfere with your medication.
• What to do if you miss a dose.
• Ensure that you maintain a continuous supply of medication especially when travelling.
• Store all tablets in original containers, clearly labelled and in a cool dry place out of reach of children.
• Avoid alcohol other than moderate social drinking.

Missed medication

Missing tablets may sometimes trigger a seizure.  The goal is to keep a constant level of the drug in the bloodstream.  If you realise that you have forgotten a dose, take advice from your doctor on what to do. 

Tips:

• Establish a regular routine to help avoid forgetting medication(s).
• Taking medication with meals or using a tablet dosette may help.
• Maintain supplies to avoid running out of medication(s) at the last minute, particularly if away from home.
• If a dose is missed it can generally be taken as soon as you remember.
• Do not double up on doses. It is important not to take the missed dose if it close to the next one.
• Keep a record of doses that have been missed.

Side effects
All anti-epileptic medications have side effects. Initially expect a few side effects until your body becomes accustomed to it. Many people find a few weeks after starting medication, the side effects tend to lessen or disappear. If they are related to the dose being too high, they can often be resolved with a reduction in dose.

Sometimes a change of medication is necessary if the effects are an allergic reaction to that particular drug, or unacceptable for the individual.

Duration of therapy
Some people may have lifelong therapy, whilst others may be able to discontinue the treatment. This will depend on:

• the type of seizures or epilepsy syndrome,
• tolerance of the drug,
• response to the drug,
• length of time seizure-free.

Social factors such as education, driving and employment also come into consideration

Stopping the medication
Never stop or alter the dose of a drug without medical advice.
Any withdrawal from antiepileptic medication should be done slowly and under medical supervision. Suddenly stopping these drugs can provoke a seizure or seizures, often more severe than usual.

Monitoring blood levels
If seizures are well controlled, blood tests are seldom necessary. The indications for monitoring blood levels include:

• Use of Phenytoin (Dilantin)
• Poor seizure control
• Use of more than one antiepileptic drug with unwanted side effects
• Epilepsy in the very young, elderly or disabled
• Other blood tests to check liver function and bone marrow are sometimes performed

It is important that epilepsy be managed under the guidance of a doctor. Obtain clear instructions how and when to take the medication and what unwanted effects may occur.

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Epilepsy Action
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