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Epilepsy Treatments: Finding the Right Medication

Could your treatment for epilepsy be better? A guide to medications to help you and your doctor decide.

By R. Morgan Griffin
WebMD Feature

Reviewed By Charlotte Grayson

Epilepsy treatment has come a long way in the last 15 years. Today, many new and effective anti-epileptic drugs (AEDs) are on the market. Though there's no cure, the prognosis for most of the 2 million people with epilepsy in the U.S. is quite good. Up to 80% of people can control their condition with medicine.

But dozens of epilepsy drugs can make things confusing. How do you know if you're getting the right one? Are there better epilepsy treatment options out there that you don't know about?

"The number of choices can seem almost staggering to people," says John M. Pellock, MD, spokesperson for the American Epilepsy Society and chairman of Child Neurology at Virginia Commonwealth University.

Experts say that many people with epilepsy do settle for treatment that could be better. They stick with the medicine -- or medicines -- they're familiar with, even if they're not working that well.

"A lot of people with epilepsy are using medications that aren't right for them," says Orrin Devinsky, MD, director of the New York University Epilepsy Center. "They're having side effects and medical problems that they don't need to have."

The new goal for epilepsy treatment is simple: No seizures and no side effects. Are you getting the best treatment possible? Or could you be doing better, too?

Is Your Epilepsy Treatment Right for You?

Good epilepsy treatment with medication is a tricky balancing act. You need enough of a medicine to stop the seizures. But if you have too much of it, you can have a lot of side effects. The key is to find a happy medium.

So there's a bit of trial and error when it comes to finding the right medication at the right dose. You may need to try a few different drugs. According to Pellock, the process of fine-tuning your medicine can take a few months.

The good news is that for most people with epilepsy, a lot of different drugs will help. "Up to two-thirds of people control their epilepsy with the first or second drug they try," Pellock tells WebMD.

But that's not always a good thing. People may quickly settle for a drug that works well enough, even though they could do better. The goal is not to find a medicine that works for you, it's to find the medicine that works best for you.

"People will wind up staying on a drug for years, even though they're having all sorts of side effects," says Pellock. "They think that their treatment is as good as it gets."

Also, the longer you're on a drug, the more used you become to the side effects.

"I see people who have been on the same medication for 10, 15, or 20 years, and they don't realize that they're having side effects anymore," Devinsky tells WebMD. "They think that sleeping 12 hours a day and always being exhausted is normal. They don't remember what it was like before they went on the medication."

1 Drug or More for Epilepsy Treatment?

For most people with epilepsy, monotherapy -- treatment with just one drug -- is the goal. Why is one drug better than two or three? The main issues are side effects.

"If you're on more than one drug, it's not just like the side effects are being added together," says Pellock. "They're multiplied."

The side effects of epilepsy drugs vary widely, but they include fatigue, nausea, vomiting, and long-term problems like osteoporosis (brittle bones.) Also, the more drugs you have, the more possible drug interactions you face.

Monotherapy simplifies things. You only have to remember to take one medicine. It's often cheaper than taking multiple drugs, too.

So when it's possible, epilepsy experts try to get patients on more than one drug down to one. The effects can be dramatic. "Sometimes, I'll have a patient who goes from two drugs to one," says Pellock, "and his memory will suddenly get better. He'll say, 'Wow, I can think clearly again.'"

However, monotherapy isn't always possible. Some people with tough cases of epilepsy just can't be controlled by one medicine.

"Monotherapy should always be the goal," says Devinsky. "But there really are some people out there who need to be on more than one drug."

Old vs. New Drugs: What's the Difference?

Beginning in the 1990s, a number of new drugs for epilepsy came on the market. Pellock says that many of the new medicines cause fewer side effects that the older ones. The American Academy of Neurology and the American Epilepsy Society generally advise that people who are newly diagnosed start on one of the newer medicines.