Epilepsy - Long-Term Treatment

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Treatment of Adults with Symptomatic Myoclonus. Myoclonus is sudden, jerky contractions that can be a symptom of epilepsy. Symptomatic, or secondary, myoclonus is usually caused by metabolic disorders or drugs. In 2005, brivaracetam was approved for treatment of symptomatic myoclonus. The drug is also being studied for epilepsy treatment

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 safe, newer ones (including gabapentin, lamotrigine, oxcarbazepine, and gamma-vinyl-GABA) may sometimes prove to be useful as a sole therapy. These newer drugs also increase patient compliance because they tend to have fewer side effects than the older ones.

Treatment of Women. Hormonal fluctuations affect epilepsy in about a third to a half of female patients. Estrogen appears to increase activity, and progesterone reduces it. The effect of pregnancy on women with epilepsy is complex. The following treatments may help or affect women with epilepsy:

• Hormonal Drugs that Suppress Ovulation. When seizures in women are worsened by hormonal changes, such as during the menstrual cycle, suppressing ovulation may be recommended using drugs called gonadotropin-releasing hormone agonists.
• Hysterectomy. Women with epilepsy who no longer wish to bear children may consider hysterectomy (surgical removal of the uterus) or oophorectomy (surgical removal of the ovaries). Each of these treatments must be accompanied by estrogen replacement therapy.
• Oral contraceptives. Antiseizure medications affect many oral contraceptives (OCs). Carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, and topiramate reduce the effects of OCs. Valproate does not, and may even increase hormonal levels. Gabapentin, lamotrigine, tiagabine, and vigabatrin may also prove to be safe with OCs, but more research is needed. Progestins may be the best contraceptive drugs for women with epilepsy at this time. Injected progestins may actually help prevent seizures in some cases.

More information on epilepsy and pregnancy can be found in this report under "Outlook and Effects."

Review Date: 11/15/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital