Download Treatments

Treatment
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Anti-epileptic drug treatment
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Anti-epileptic medications used well are the most
effective way of controlling seizures
AEDs only suppress and control seizures; they
do not treat the cause of the epilepsy
They need to be taken regularly as prescribed;
failure to do so can result in potentially fatal
‘rebound’ seizures
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Anti-epileptic drug treatment
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Know (as far as you can) that the diagnosis of
epilepsy is correct. Question the diagnosis
tactfully prior to prescribing AEDs
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Know which medications are reliably available
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Know which of these medications are affordable
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The importance of lifestyle
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How important is it that the person attains
seizure control? Do they want/need
medication?
What about employment issues, driving,
pregnancy, stigma/social exclusion
How much of a risk is SUDEP for them?
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AED treatment plan
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Choose an AED that is right for the seizure type
Choose the AED in the light of other medication
the person may be taking
Ask about lifestyle and life plans before
prescribing, being aware of potential side effects
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Starting treatment
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Monotherapy is preferable as it keeps side effects and drug
interactions to a minimum and keeps dosing simple
“Start low, go slow” is the motto. Start on a low dose and
slowly increase the dosage until the person attains seizure
control or experiences undesired side effects.
Some people will attain seizure control on low doses, others
can tolerate high doses with good effect and no side effects.
Each person and their epilepsy is individual!
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Side effects
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What side effects might the person experience
on the medication they are going to be taking?
And will detrimental (potential) side effects
outweigh the benefits of treatment?
Warn the person what they may expect in the
way of side effects so they know what to report
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Side effects
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Some side effects may diminish over 7 – 14
days, once the body has become accustomed to
the medication
If side effects persist and are detrimental to the
persons quality of life, it is appropriate to discuss
changing drug treatment
Most side effects are dose related and will go
once the medication has been reduced or slowly
tapered off
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Serious side effects
Some people may experience rare
idiosyncratic side effects such as severe
rash
These are dangerous and the medication
needs to be stopped with medical
supervision in case sudden withdrawal
causes seizures
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Changing AEDs
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Changing AEDs needs to be done slowly
Particularly with the older medications,
there are likely to be adverse effects if the
AED reduction is not done very slowly
Choose another appropriate first line drug
and again “start low and go slow”
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Adding a second medication
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This needs to be done only if
monotherapy has failed
2 or 3 drugs in combination makes for
potentially complicated drug interactions
and a greater risk of side effects
It can be hard to ascertain which
medication is causing adverse effects
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AEDS for women of, or approaching
child bearing age
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Be aware that some AEDs reduce the
effectiveness of the contraceptive pill
Some AEDs are associated with a higher risk of
foetal malformations if taken during pregnancy
(seizure control during pregnancy is important)
Taking folic acid supplements can reduce the risk
of neural tube defects (spina bifida)
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Remission
How do you know when the epilepsy has
gone into remission making treatment no
longer necessary?
You don’t !
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All you can do is:
Assess the type of epilepsy:
 Primary generalised idiopathic epilepsies
have a higher rate of remission
 Seizures caused by head injury are not
likely to remiss as the cause is still present
Discuss the potential consequences for the
person of coming off treatment; how will
their life be effected if seizures return?
(driving, employment pregnancy, stigma)
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Check key websites for the latest
information
National Society for Epilepsy UK
www.epilepsynse.org.uk
Epilepsy Action UK
Drugwatch - Keep up to date with the latest alerts and news
relating to epilepsy medication
www.epilepsy.org.uk/drugwatch
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Useful websites
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The international League Against Epilepsy:
www.ilae-epilepsy.org
The International Bureau for Epilepsy
www.ibe-epilepsy.org
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