Epilepsy - Medications

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There is some debate about whether to treat every adult patient with an AED after a single initial seizure. Some doctors do not recommend treating adult patients after a single seizure if they have a normal neurologic examination, EEG, and imaging studies.

Febrile Seizures. Most children who have a febrile seizure do not have a seizure disorder and generally do not require drug treatment to prevent more seizures. In very rare cases, children experience severe fever-related seizures known as complex febrile convulsions. In such cases, there is a risk for brain injury that may lead to temporal lobe epilepsy, but this risk is very small. Complex febrile convulsions last over 15 minutes, occur more than once within 24 hours, and may affect only one side of the body.

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Determining an Anti-Epileptic Drug (AED) Regimen

Epileptic seizures can often be controlled using a single-drug regimen. First-line AED drugs include phenytoin (Dilantin, generic), carbamazepine (Tegretol, generic), and divalproex sodium (Depakote, generic). Patients generally begin with low doses and build up until the seizures are controlled or a toxic reaction occurs. If a single drug fails to control seizures, other drugs are added on. The specific drugs and whether more than one should be used are determined by various factors, including the patient's age and the seizure type, frequency, and cause.

Treatment If Seizures Still Occur

Drugs fail to control epilepsy in about a third of patients. For patients who have little or no benefit from their initial drug regimen the likelihood of good or complete control from different medications or multidrug regimens is not very high.

Reasons for Failure. An AED may fail to reduce seizures due to such factors as:

• The wrong dose level.
• Improper timing.
• Introducing the medication too rapidly.
• Not managing conditions that triggered the seizure.
• Instability of the drugs. Many of the tablet forms disintegrate easily with moisture, so pills should be stored in a dry place, not in the bathroom, and kept away from heat.
• Patients not taking medication as prescribed. Some patients experience difficult side effects from older AEDs, which often cause them to stop medications. Among the most distressing are sleepiness, problems in coordination, and weight gain.
• Some patients who do not respond to AEDs may actually have nonepileptic seizures.