Treatment with Medicine

When the doctor has made a diagnosis, the next step is to select the best form of treatment.

If the seizure was caused by an underlying condition that can be corrected, such as a tumor in an area that can safely be removed, then treatment -- in this case, surgery -- will correct that problem and the seizures will probably not return.

If epilepsy -- that is, a continuing tendency to have seizures -- is diagnosed, the doctor will usually prescribe regular use of seizure-preventing drugs. More than twenty medications are available to treat epilepsy. If medicines are not successful in preventing seizures, other methods may be tried, including surgery, a special diet or vagus nerve stimulation (VNS).

The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for you to lead a normal, active life.

Treating Epilepsy Through Medicine

Most epilepsy medicines are taken by mouth in the form of tablets, capsules, sprinkles, or syrup. The following are commonly prescribed to prevent seizures:

Carbamazepine (brand names, Tegretol, TegretolXR, Carbatrol); clonazepam (Klonopin); ethosuximide (Zarontin); phenobarbital; phenytoin (Dilantin); primidone (Mysoline); valproic acid (Depakene); and divalproex sodium (Depakote). Several others may also be prescribed.

Newer drugs which are also prescribed for epilepsy include felbamate (Felbatol); gabapentin (Neurontin); lamotrigine (Lamictal); levetiracetam (Keppra), oxcarbazepine (Trileptal); tiagabine (Gabitril); topiramate (Topamax) and zonisamide (Zonagran). Other new drugs are in development.

A rectal gel form of diazepam (Diastat) maybe prescribed for parent or caregiver use in stopping cluster seizures or prolonged seizures. Some doctors may prescribe pills of diazepam (Valium), lorazepam (Ativan), or clonazepam (Klonopin) for the same purpose.

A steroid drug, ACTH, may be given by injection to treat children with a type of epilepsy called infantile spasms, or for severe seizures that can't be controlled with other drugs. It is usually given by a doctor who has had special training in using this medicine for epilepsy.

The doctor's choice of which drug to prescribe depends on what kind of seizure a person is having. Different drugs control different types of seizures.

People also react to these medicines in different ways. Some experience side effects, others may not. Some people's bodies break down medicines at a faster or slower rate than the average person. Some people's seizures will respond well to a particular drug while someone else will have seizures that continue. With all this variation, it may take some time to find exactly the right dose of the right drug for each person who has a seizure disorder.

Taking medicine on time every day replaces the medicine that your body has used up since the last dose. Taking medicine on time keeps a steady level of the seizure-preventing drug in the body. Taking medicine regularly gives your treatment the best chance of success.

Missing doses, allowing the prescription to run out, or taking fewer pills than suggested may make the drug level in your body too low to do its job. Then the seizures are likely to start again.

Side effects of medicine

All medicines can cause side effects. Drugs that prevent seizures can cause side effects too, even though many people take them for long periods of time with no unpleasant side effects at all.

Some side effects (like feeling very tired, or nauseated) are more likely to happen when a drug is first started. They may go away later on.

Other side effects may happen because one drug you are taking is affecting another one, and the two together are making you feel uncomfortable in some way.

A third possibility is that too much medicine is building up in your blood and the level is becoming "toxic." Feeling very tired, staggering, or slurring your words can all be signs of this.

Some people have an allergic reaction (like a rash) to a drug. The reaction may be caused by only a small amount of the drug. When this happens, a different drug may have to be used instead.

Each drug has its own list of possible side effects. Ask your doctor about the drug you are taking. Ask what to watch out for, and what to do if problems occur.

How many drugs?

If you are taking several different drugs to prevent seizures (especially if you're still having some seizures and feel very tired all the time), ask your doctor whether treatment with one medicine might work for you.

Of course, you may be one of the people who still needs more than one medicine to prevent seizures. Or, you may be someone who'll continue to have some seizures no matter what. Still, it's well worth checking with your doctor in case a change of treatment can help you. Surgery, the vagus nerve stimulation (VNS) implant, or the ketogenic diet may be treatment options to consider.