Epilepsy - Long-Term Treatment

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• 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.
• Toxicity. Some research indicates that over 40% of patients experience toxic effects from older AEDs, which often causes them to withdraw. Among the most distressing are sleepiness, problems in coordination, and weight gain.
• Some evidence suggests that about a quarter of patients who do not respond to AEDs actually have nonepileptic seizures that in many cases are caused by psychiatric conditions (panic attack, personality disorders).

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 at a time 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, despite a number of new medications on the market. In such cases, the patient should ask about surgical alternatives.

Noncompliance. Failure to take medication as prescribed is a serious problem, particularly in young people. It is extremely important to take a drug exactly prescribed by the doctor as not doing so can lead to seizures. Studies have shown that uncontrolled epileptic attacks lead to changes in the neurons that may cause intractable epilepsy.

Healthy Behaviors. In young people, a positive attitude, continued support from family and health care providers, emotional well-being, and good treatment results can increase patient compliance. Unhealthful behaviors, such as smoking and alcohol use, can have a negative effect.

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. Many experts feel, however, that these blood tests are a less reliable indicator of problems than the patient's own self-observations of his or her responses 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.

General Information on Side Effects of AEDs

All anti-epileptic drugs have side effects, which vary depending on the drug. Increasingly, however, AEDs are being designed to specifically target mechanisms causing seizures, and should have fewer widespread effects. The complexity and potential severity of side effects are amplified when more than one drug is used. Seizures themselves can be a side effect of AEDs.

Some problems common to many of the AEDs include: