Treatments and drugsBy Mayo Clinic staff
Not 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.
Many medications are used in the treatment of epilepsy and seizures, such as:
- Carbamazepine (Carbatrol,Tegretol, others)
- Phenytoin (Dilantin, Phenytek)
- Valproic acid (Depakene, Stavzor)
- Oxcarbazepine (Trileptal)
- Lamotrigine (Lamictal)
- Gabapentin (Gralise, Neurontin)
- Topiramate (Topamax)
- Zonisamide (Zonegran)
- Levetiracetam (Keppra)
- Tiagabine (Gabitril)
- Pregabalin (Lyrica)
- Felbamate (Felbatol)
- Ethosuximide (Zarontin)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
Finding the right medication and dosage can be challenging. 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.
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.
Mild side effects of anti-seizure medications can include:
- 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
In addition, the drug Lamictal has been linked to an increased risk of aseptic meningitis, an inflammation of the protective membranes that cover the brain and spinal that's similar to bacterial meningitis.
Pregnancy and seizures
Women who've had previous seizures usually are able to have healthy pregnancies. Birth defects related to certain medications can sometimes occur. In particular, valproic acid has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. Topiramate (Topamax) has been linked to an increased risk of birth defects, particularly cleft lip and cleft palate, for pregnant women who take the drug in their first trimester.
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 change the dose of seizure medication before or during pregnancy. Medications may be switched in rare cases.
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.
- 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 March 22, 2011.
- FDA warns about potential Topamax related birth defects. FDA Reports. http://www.fda-reports.com/alerts/?p=187. Accessed March 23, 2011.
- FDA: Aseptic meningitis risk with use of seizure drug Lamictal. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm222212.htm. Accessed March 23, 2011.
- American Academy of Neurology. Practice parameter update: Management issues for women with epilepsy — Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes. Neurology. 2009;73:133. http://www.neurology.org/cgi/content/abstract/WNL.0b013e3181a6b312v1. Accessed March 23, 2011.
- Shallcross R, et al. Child development following in utero exposure: Levetiracetam vs sodium valproate. Neurology. 2011;76:383.
- Stafstrom CE, et al. Pathophysiology of seizures and epilepsy. http://www.uptodate.com/index/home.html. Accessed March 22, 2011.
- Seizure disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch214/ch214a.html. Accessed March 22, 2011.
- Schachter SC. Evaluation of the first seizure in adults. http://www.uptodate.com/index/home.html. Accessed March 22, 2011.
- Zupanc M. Epilepsy in infants and children. In: Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0986-5..C2009-0-38984-9--TOP&isbn=978-1-4377-0986-5&about=true&uniqId=236797353-5. Accessed March 22, 2011.