Epilepsy - Medications

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Children who tend to relapse after withdrawal from treatment usually have the following conditions or situations:

• A family history of epilepsy
• Require multiple medications to control seizures
• Abnormal EEG readings after treatment has started
• Partial seizures

Treatment of the Elderly

Anti-epileptic drugs interact with many other drugs, and may cause special problems in older patients who use multiple medications for other health problems. Elderly patients should have liver and kidney function tests performed before starting antiseizure medication. Standard drugs are usually effective, while newer ones (including gabapentin, lamotrigine, oxcarbazepine, and gamma-vinyl-GABA) may sometimes be used as a sole therapy. These newer drugs also tend to have fewer side effects than the older ones.

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Treatment During Pregnancy

Preparing to Become Pregnant. Women with epilepsy who are considering pregnancy should talk to their doctors before they become pregnant. According to practice guidelines from the American Academy of Neurology and the American Epilepsy Society:

• A woman who has been seizure free for at least 9 months before becoming pregnant has a good chance of remaining seizure free during pregnancy.
• Folic acid is recommended for all pregnant women. Women with epilepsy should talk with their doctors about taking folic acid supplements at least 3 months before conception as well as during the pregnancy.
• Women with epilepsy do not face a substantially increased risk of premature birth or labor and delivery complications (including cesarean section). However, women with epilepsy who smoke may face a higher risk of premature delivery than women without epilepsy who smoke.
• Babies born to mothers who use an AED during pregnancy may be at increased risk of being small for their gestational age. But evidence does not indicate that these babies face an increased risk of dying in the first month after birth.

Medication Use During Pregnancy. Women should discuss with their doctors the risks of anti-epileptic drugs (AEDs) and the possibility of making any changes in their drug regimen in terms of dosages or prescriptions. According to current guidelines: