Anti-epileptic drugs are used to prevent seizures from occurring rather than treating them when they have happened. It is therefore necessary to take medication regularly and consistently. In order to prevent further seizures from happening it may be necessary to take medication for long periods, sometimes many years.
There are a large number of different anti-epileptic drugs and they are effective for different types of seizures. The doctor will choose the most effective drug for an individual’s seizure type or types.
When somebody starts taking anti-epileptic drugs, they are usually introduced gradually, and the dose increased slowly until it is at a level where it is either controlling the seizures or the person starts to experience side effects. If the drug does not control the seizures, or if the side effects are unacceptable another drug might be tried. Most people will have their seizures controlled by one anti-epileptic drug (monotherapy). For a small number of people, however, it may be necessary to take more than one type of anti-epileptic drug (polytherapy) in order to control the seizures.
WHEN CAN I STOP TAKING MEDICATION?
If somebody has not had a seizure for two or more years the doctor may suggest coming off the medication. When stopping medication, the dose must be reduced slowly and always under medical supervision. There can be risks in stopping treatment suddenly as it can lead to frequent and sometimes prolonged seizures. This is true even if the medication was not successful at controlling the seizures. However, in some epilepsy syndromes medication should be lifelong as there is a very high risk of relapse.
The consequences of a recurrence of seizures, such as the loss of driving licence and the employment situation, are usually discussed before withdrawing treatment.
Most people do not experience any withdrawal symptoms providing the drug is withdrawn slowly as the doctor directs. Anti-epileptic drugs that may result in withdrawal symptoms include the benzodiazepines: diazepam (Valium), clonazepam (Rivotril) and clobazam (Frisium). The symptoms may include feelings of anxiety and panic, restlessness, sweating and an increase in seizures.
WHAT ABOUT SIDE EFFECTS?
All drugs, including anti-epileptic medication, have the potential to cause side effects. This does not mean that everybody taking a particular drug will experience them. Side effects can be divided into three main categories:
These are rare and occur because an individual is sensitive to the drug. They often take the form of an itchy skin rash and usually occur soon after treatment is started. If you think you are experiencing an allergic reaction it is important to seek medical advice.
These are the more common type of side effect and usually occur when the dose of the drug being taken is too high for that individual. If the dose is reduced, or the schedule for taking the drug is altered, the side effects should disappear. The most common side effect is a feeling of drunkenness, but people can also experience drowsiness, dizziness, unsteadiness, slurred speech, poor concentration and memory.
Long term (chronic) effects:
These are also rare, and can occur if somebody has been taking a drug over a long period of time. It tends to affect people more if they are taking a combination of drugs rather than just one. Side effects could include swelling of gums, acne and weight gain. As with the dose related effects, reducing the dose, or altering the medication can often alleviate these symptoms.
WILL THE ANTI EPILEPTIC DRUGS INTERACT WITH ANY OTHER MEDICATIONS?
Some medication can interact with anti-epileptic drugs. It is therefore important to check before taking any other medication either prescribed or over the counter treatments.
It may be a good idea to have your prescription dispensed from the same pharmacist who knows about your epilepsy.
Some anti-epileptic drugs make certain other drugs less effective. The contraceptive pill is an example of this, so some women with epilepsy may need to use a higher dose pill if they are taking anti epileptic medication.
Breakthrough bleeding can be a sign that the dose of the pill is not high enough and that it will not be providing adequate contraceptive protection. There is more information in the women and epilepsy leaflet.
WHAT ABOUT RECREATIONAL DRUGS?
Amphetamines, ecstasy, cocaine and heroin have all been associated with seizures in people without epilepsy. These drugs have also been shown to increase the frequency of seizures in people with epilepsy. There are also social and legal implications of using illicit recreational drugs to be considered.
IS IT OK TO DRINK ALCOHOL?
Excessive alcohol and binge drinking can affect seizure control but it is not usually a problem when alcohol is taken in moderation. It is important to remember to take your medication at the specified time, and too much alcohol may cause you to forget to take it.
WHAT IF I FORGET TO TAKE MY ANTI EPILEPTIC MEDICATION?
It is important that the medication taken for epilepsy is taken regularly and as prescribed by the doctor. However, missing a single dose on a rare occasion is unlikely to be dangerous and result in seizures. A drug wallet can help if remembering to take your medication is a problem.
BRAND NAME OR GENERIC NAME DRUGS?
After a licence period, it is permissible for any licensed company to manufacture a generic anti epileptic drug. Some people have experienced a change in their seizure threshold as a result of changing brands. If you are concerned, ask your GP to write the brand name on your prescription
If necessary, take your old medication packaging along with you when you renew your prescription to ensure that you have the same drug.