Drug Therapies for Epilepsy

The principal mode of treatment for epilepsy is with medication called anti-epileptic drugs (AEDs). Despite their name, anti-epileptic drugs do not "cure" epilepsy or seizures and do not change the brain's underlying susceptibility to produce seizures. They only treat the symptoms of epilepsy by reducing the frequency of seizures. They are also often referred to as anticonvulsant drugs.

There are many AEDs available on the market and new ones are in development. Which drug is used depends on the condition and the child being treated. Medication treatment must be tailored specifically to suit each situation.

For certain syndromes, other types of drugs may be used, either alone or in combination with AEDs. For example, a steroid called adrenocorticotropic hormone or ACTH is sometimes used to treat a specific type of seizures in young children, infantile spasms.

When reading the information in this section, remember that the information we have about AEDs comes from clinical trials and past experience. These tell us what has happened and what is likely to happen in terms of effects, side effects, and so on, but they cannot tell us for certain what will happen to your child.

Although there is a good chance of success, AEDs do not always work. At the start of treatment, it is impossible to tell for certain whether a child will benefit from the treatment or not. Studies indicate that AEDs are most effective in children who began having seizures when they were less than 12 years old, who did not have neonatal seizures, who have normal intelligence, and who had fewer seizures before beginning treatment.

Generally, medication is tried first before trying other forms of treatment. Other forms of treatment are usually only tried if medication fails to reduce the seizures or produces unacceptable side effects. Surgery for seizures may be recommended earlier if the cause of seizures is identified to be a brain lesion that is growing, such as a tumour.

For most children, medication is all that is needed to control seizures. A Nova Scotia study of 417 children with generalized tonic-clonic and partial seizures (with or without secondary generalization) found that for 83% of the children, the first AED successfully controlled their seizures. Some of the remaining 17% gained seizure control on another AED or a combination of AEDs.

When to use AEDs

AEDs are usually not given at the first sign of a seizure. Half the children who have one seizure never have another. However, a second seizure greatly increases the chance of having more seizures, so treatment is usually considered at this point. In many cases, AEDs are very effective: 20% of children on AEDs never have another seizure, and others will have them only occasionally. However, it is impossible to tell for certain at the start of treatment whether an AED will stop a particular child from having seizures.

Questions about anti-epileptic drugs for your child's doctor

Here are some questions you may want to ask when the doctor prescribes an anti-epileptic drug for your child:

• What are the chances that this medication will control my child's seizures?

• What dose is my child taking?

• What is the dosing schedule (once a day, twice a day, three times a day)?

• Is it possible to take the medication only twice a day, or switch to another medication that only needs to be taken twice a day?

• How rigid is the dosing schedule? If my child takes the medication half an hour early or an hour late, will that be a problem?

• Does the dose need to be titrated (that is, gradually increased over time)?

• What can I expect while my child is taking this medication?

• How long will it take before we know if the medication is working?

• What kinds of physical side effects might there be?

• What kinds of cognitive or learning side effects might there be?

• What kinds of behavioural side effects might there be?

• How long can we expect the side effects to last?

• Does this medication have any serious side effects, for which we would need to contact a doctor or emergency services? How can we recognize those side effects?

• Does this medication interfere with other medications?

• What should we do if my child misses a dose of this medication?

• What should we do if my child accidentally takes too much of this medication?

• How often should my child come in for a follow-up appointment while taking this medication?

• Is there anything I should tell my child's school about this medication?

• How long will my child be taking this medication?

For more information

This section contains information on:

• Choosing an AED

• Commonly used AEDs

• Side effects and drug interactions

• Drug monitoring

• Helping your child take AEDs

• Discontinuing AEDs

Click the links on the left to learn more.