Goal of Drug Therapy
'When selecting a drug, your doctor will consider the type of seizures you have. Not all medications
work for all types of seizures. Not everyone responds to the same medication and
it can sometimes
be a trial and error process to find the right medication for seizure control.'
Monotherapy or Polytherapy
Monotherapy is usually the preferred treatment, with a single drug prescribed in increasing increments until seizures are controlled or toxicity occurs. If the drug is ineffective or side effects are troublesome, the first drug is slowly withdrawn while an alternative is slowly introduced.
Monotherapy has the advantage of reducing the possibility of drug interactions and is usually easier for people to comply with. However, some people will require more than one medication to control or reduce their seizures—polytherapy. When this is necessary, no more than one new medication is generally added at a time so that interactions or side effects can be tracked and assigned.
Whether you're considering one antiepilepsy drug or a combination, you and your doctor should consider:
Your type of epilepsy, because some types respond better than others to specific medicines.
Your age, gender and other health issues.
How the antiepilepsy drugs work and possible side effects.
Other medicines you're taking.
What side effects are likely with different antiepilepsy drugs.
What kinds of side effects are acceptable to you.
What you hope to gain from medicine, for example, to be more alert during the day so you can participate better in school, work or family activities.
What your future plans are, for example, if you are a woman and plan to have a family.
Whenever possible, doctors try to prevent seizures with a single medication. This is called monotherapy.
However, some people may require polytherapy, the use of more than one medication to achieve seizure control.
When selecting a drug, your doctor will consider the type of seizures you have. Not all medications work for all types of seizures.
Your doctor will also consider how the medications may affect you. People react individually to medicines just as they do to other substances that enter the body, and one person may experience side effects while another may not. What all this means is that doctors may have to try several medications to find one that is effective for you.
With so much variability among people, it may also take some time to customize the dosage of medication. One of the ways your physician determines how much medication you need to take is to measure how much of it is present in your blood. Some medicines reach an effective, seizure-preventing level in the blood more quickly than others.
Knowing how much medication is in your blood shows how much medication is getting up to your brain, where seizures occur.
If seizures are not controlled and the level is low, the dose of medication may have to be increased. If the level is too high, side effects are more common and the dose may be reduced.