Epilepsy - Medications

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The doctor should first address these issues. If the patient still does not respond, the doctor will usually try a different drug. If this fails, one or even two additional drugs may be used. When seizures do not respond to the first two or three drugs, the odds of a fourth or fifth working diminish greatly. In such cases, the patient should ask about surgical alternatives.

Healthy Behaviors. Unhealthy behaviors, such as smoking and alcohol use, can interfere with medication effectiveness.

Monitoring Effects

During the first few months of therapy, the doctor will probably order blood tests once or twice to monitor drug levels and, if necessary, adjust dosages. Monitoring is used to check for AED complications, and to be sure the patient is complying with the regimen. These blood tests may be, however, a less reliable indicator of problems than patients’ own self-observations of response to the drug. For instance, blood tests may suggest that the dosage levels are insufficient according to general standards, yet the individual patient may be seizure-free and leading a normal life. It is very important that women have AED levels monitored during pregnancy (see "Treatment During Pregnancy" below).

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Discontinuing Drug Therapy

Patients who can generally withdraw from medications and remain seizure free within a five-year period include those who:

• Respond well to anti-epileptic drugs , as indicated by good control of seizures within the first year
• Do not have risk factors for more severe epilepsy

In general, patients who do not have good control with medications after the first year are more likely to have difficulty with epilepsy treatment. Other indications of more difficult-to-control epilepsy are:

• Multiple types of seizures have occurred
• Abnormal EEG readings
• Abnormal neurologic findings on physical exam
• Lesion or abnormality seen on MRI scan

Most patients who have responded well to medications can stop taking AEDs within 5 - 10 years. Evidence suggests that medications in children should not be halted for at least 2 years after the last seizure, particularly if they have partial seizures and abnormal EEGs. It is not clear whether children who have been free of generalized seizures need to wait more than 2 years or if they can withdraw earlier.