Medical Management

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Epilepsy today is largely treated with medication.  Medications to control seizures are called antiseizure medications (ASMs) and they are intended to reduce or stop seizures, preferably with few side-effects. They are not a cure and need to be taken every day to keep the seizures under control.

Finding the right medication for you

Some people get good seizure control with the first medication they try, however others may need to trial more than one medication before they find the one that works best for them.

The choice of medication depends upon the seizures, epilepsy type or syndrome, age, gender, other health conditions, lifestyle, employment and side effects. Your doctor will consider these things before prescribing one for you.

Your doctor will give you instructions on how and when to take the medication and any possible unwanted side-effects that may occur. The pharmacist should also help with any questions.

However, sometimes finding the best epilepsy medication can be complicated and your doctor may need to change the medication or dose from time to time to better control your seizures or reduce unwanted side effects.

General guidelines:

Take your medication as prescribed. Changing the dose or daily routine may provoke unexpected seizures or side effects. If you are not happy with your medication for some reason, contact your neurologist.

Read the manufacturer’s instructions and information.

When medication is prescribed, ask your doctor:

  • What to expect when starting the medication
  • What other medicines may interfere with your medication or vice versa
  • What side effects should you be concerned about
  • What to do if you miss a dose
  • How to keep a good supply so you don’t run out
  • Any specific instructions about storing the medication
  • About drinking alcohol or other drug use
  • About considering future pregnancies.

Missed medication

It is common for people to occasionally forget their medication, so it is worth discussing with your doctor what to do if this happens.

For good seizure control, it is important to keep stable levels of the antiseizure medication in the bloodstream.  Missing medication may sometimes cause a seizure. If you realise that you have forgotten a dose, speak to your doctor so you know what to do.

Listen to Dr. Dan McLaughlin discussing what to do about missing medications.

Tips that may help if you regularly miss your medication:

  • Have a regular routine when taking your medication so you are less likely to forget
  • Take the medication with meals or using a tablet dosette box
  • Keep good supplies to avoid running out of medication(s) at the last minute, particularly if you are away
  • If a dose is missed it generally should be taken as soon as you remember.
  • Do not double up on doses. It is important not to take the missed dose if it is close to the next due dose
  • Keep a record of doses that have been missed.

Side effects

All antiseizure medications have side effects especially when the medication is first started. Many people find a few weeks after starting, the side effects tend to lessen or disappear. If the side-effects are related to the dose being too high, they often diminish with a reduction in dose.

The prescribing doctor needs to be made aware, especially if the side-effects persist, are intolerable or are listed as serious.

Sometimes a change of medication will be needed if the effects are an allergic reaction or unacceptable for that person.

Contraception and pregnancy

Some antiseizure medication can reduce the effectiveness of the contraceptive pill and some contraceptive pills can affect the uptake and absorption of some antiseizure medication. This may mean that the type or dose of contraception may need to be changed.

Some antiseizure medication are also known to have a higher risk of causing birth defects so women who are planning a pregnancy should plan well ahead and discuss medication choice with the neurologist.

Stopping the medication

Never stop or change the dose of a medication without speaking to your doctor.

Any withdrawal from antiseizure 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

Most people with epilepsy do not need regular blood level monitoring. There are some situations where medication blood level monitoring is needed such as when someone is:

  • taking phenytoin (Dilantin)
  • having more seizures than usual or changes in seizures or seizure control
  • taking many medications
  • a young child, elderly or disabled
  • having what are thought to be unwanted side effects
  • suffering from another medical condition

For more information go to:

Video: Dr. Andrew Bleasel – Seizure Control

Video: Dr. Dan McLaughlin – Missed Medication

Younger children may have difficulty swallowing tablets. For information click here.

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