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Treatments and drugs
By Mayo Clinic staffNot everyone who has one seizure will have another one, and because a seizure can be an isolated incident, your doctor may decide to not start treatment until you've had more than one. Treatment usually involves the use of anti-seizure medications.
Medications
Many medications are used in the treatment of epilepsy and seizures, such as:
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin)
- Valproic acid (Depakene)
- Oxcarbazepine (Trileptal)
- Lamotrigine (Lamictal)
- Gabapentin (Neurontin)
- Topiramate (Topamax)
- Phenobarbital
- Zonisamide (Zonegran)
- Levetiracetam (Keppra)
- Tiagabine (Gabitril)
- Pregabalin (Lyrica)
- Felbamate (Felbatol)
Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage, and then increase the dosage gradually until your seizures are well controlled. Many people with epilepsy are able to prevent seizures by taking only one drug, but others require more than one.
If you've tried two or more single-drug regimens without success, your doctor may recommend trying a combination of two drugs.
Mild side effects of anti-seizure medications can include:
- Fatigue
- Dizziness
- Weight gain
More-troubling side effects that need to be brought to your doctor's attention immediately include:
- Mood disruption
- Skin rashes
- Loss of coordination
- Speech problems
- Extreme fatigue
To achieve the best seizure control possible, take medications exactly as prescribed. Always call your doctor before adding other prescription medications, over-the-counter drugs or herbal remedies. And never stop taking your medication without talking to your doctor.
Pregnancy and seizures
Women who've had previous seizures will have healthy pregnancies in over 90 percent of cases. Birth defects related to certain medications can sometimes occur. Discuss these risks with your doctor. Because of the risk of birth defects, and because pregnancy can alter medication levels, preconception planning is particularly important for women who've had seizures. In some cases, it may be appropriate to reduce seizure medication prior to pregnancy, and medications may be switched in rare cases. The American Academy of Neurology recommends that women avoid using valproate during pregnancy because of risks to the baby. If your seizures can't be well controlled with any other medication, discuss the potential risks with your doctor.
Contraception and anti-seizure medications
It's also important to know that some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.
- Ropper AH, et al. Epilepsy and other seizure disorders. In: Ropper AH, et al. Adams and Victor's Principles of Neurology. 9th ed. New York, N.Y.: McGraw-Hill Medical Pub. Division; 2009. http://www.accessmedicine.com/content.aspx?aID=3632229. Accessed April 22, 2009.
- Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm?css=print. Accessed April 24, 2009.
- Seizure disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch214/ch214a.html. Accessed April 26, 2009.
- Stafstrom CE, et al. Pathophysiology of seizures and epilepsy. http://www.uptodate.com/index/home.html. Accessed April 17, 2009.
- Sheth RD. Epilepsy in infancy and childhood. In: Rakel RE, et al. Rakel & Bope: Conn's Current Therapy 2008. 60th ed. Philadelphia, Penn.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/134947244-2/834264406/1621/460.html?printi. Accessed April 26, 2009.
- Elger CE. Modern management of epilepsy: A practical approach. Epilepsy and Behavior. 2008;12:501.
- Practice parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence based review): Teratogenesis and perinatal outcomes. St. Paul, Minn.: American Academy of Neurology. http://www.neurology.org/cgi/content/abstract/WNL.0b013e3181a6b312v1. Accessed April 27, 2009.
- Britton JW (expert opinion). Mayo Clinic, Rochester, Minn. May 14, 2009.
