Anti-seizure medication

Some anti-seizure medications are more suitable for different seizure types than others

Depending on your situation, your healthcare provider will discuss the best option for you. Read more about the different types of seizures.

The following is a guide to the main anti-seizure medications used for different seizure types:

• Absence seizures: sodium valproate, ethosuximide, lamotrigine.
• Atonic and tonic seizures: sodium valproate, lamotrigine.
• Generalised tonic-clonic seizures: sodium valproate, lamotrigine, carbamazepine, levetiracetam, clobazam.
• Focal seizures: carbamazepine, lamotrigine, sodium valproate, levetiracetam, oxcarbazepine, topiramate, lacosamide.
• Myoclonic seizures: sodium valproate, levetiracetam, topiramate, clobazam.

Deciding on which anti-seizure medication is best for you depends on many things, such as:

• your type of seizures
• your age
• the possible side effects of the anti-seizure medications and how they might impact on your lifestyle  
• other medicines you're taking for other conditions, and possible interactions with these
• whether you're pregnant or planning a pregnancy – read more about epilepsy and contraception. Also see anti-seizure medicines and pregnancy.

Your healthcare provider can discuss the best medicine for you. It may take some time to find the anti-seizure medication that works best for you.

In most cases, only 1 anti-seizure medication is needed to prevent seizures, but some people may need 2 or more medications.

Anti-seizure medicines provide significant benefit to people with epilepsy, including people who are pregnant. However, sodium valproate and topiramate are associated with an increased risk of adverse effects if taken during pregnancy.

Avoid sodium valproate (Epilim ®) or topiramate if there is any chance you could become pregnant

Sodium valproate or topiramate aren't suitable for people who could become pregnant.

• If you’re a person of child-bearing age and you could possibly get pregnant, you should avoid valproate or topiramate, if possible.
• If used during pregnancy, there's a risk of harm to an unborn baby, as well as long-term developmental disorders once they are born.
• There are many other anti-seizures medicines that are safe to use during pregnancy.
• If sodium valproate or topiramate are the best choice for you despite this, it’s important you understand the risks.
• Talk to your healthcare provider about this and ensure you use 2 methods of effective contraception so you avoid unplanned pregnancy.
• If you think you are pregnant, make an urgent appointment with your GP. Your GP will refer you immediately to your specialist who will then advise you further.

If you can father children and are taking sodium valproate

• Most anti-epileptic medications are safe in males. However, if you father a child while you are taking valproate or in the 3 months after stopping valproate, there is an increased risk of the child being diagnosed with a mental or movement related developmental disorder (neurodevelopmental disorder).
• Talk to your healthcare provider about the potential risks, and suitable contraception to avoid pregnancy. You and your partner should both use contraception while you're taking sodium valproate and for at least 3 months after stopping.

Planning on getting pregnant

• If you wish to start a family, it’s important to plan your pregnancy ahead of time. It’s important not to stop taking your anti-seizure medications without the guidance of your healthcare provider.
• Talk to your healthcare provider about the best epilepsy medication for you, during your pregnancy and for when your baby arrives.
• There are many anti-seizures medicines that are safe to use during pregnancy.
• Also, all women who are planning a pregnancy are advised to take folic acid before conception (before they get pregnant), to reduce the chance of neural tube defects, such as spina bifida.

For more detailed information, read more about epilepsy and pregnancy and epilepsy and contraception.

Also see:

• the risks and benefits of taking anti-seizure medicines if you are pregnant or planning a pregnancy(external link)
• medicines for epilepsy, mental health and pain can harm your unborn baby(external link)
• epilepsy medicines and pregnancy.(external link)

All anti-seizure medication can have side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine. Some side effects may impact on your lifestyle more than others and they can be life-threatening.

• Common side effects when starting anti-seizure medication include tiredness, feeling sleepy, dizziness, dry mouth, feeling sick (nausea), diarrhoea (runny poos) and stomach upset. These usually go away as your body gets used to the medicine. 
• Life-threatening side effects that are possible with some anti-seizure medication include severe skin reactions, problems with your liver and problems with your blood cells such as your white blood cells or platelets.

Talk to your healthcare provider about possible side effects of your medicines.

To help reduce your chance of side effects, your healthcare provider may start you on a low dose, then gradually increase it – this allows your body to slowly get used to the medicine. They may also ask you to have blood tests to make sure you’re taking the right dose and check you don't have serious side effects. 

 Read more about medicines and side effects and reporting a reaction you think might be a side effect. 

The decision about when to start medication can be difficult. One seizure may not mean that you will have another, and a second seizure may not occur until years later. 

A common option after a first seizure is to wait and see. If you have a second seizure within a few months more are likely, so it may be a good idea to think about starting anti-seizure medication.

Assessing the benefits and risks

The decision to start anti-seizure medication should be made by thinking about the benefits and risks of starting the medicine. This will depend on how your seizures affect you and how often they happen.

The following are risks and benefits of ASMs to think about before making your decision.

Risks of taking anti-seizure medicines

• Having side effects from the medicine.
• Needing to remember to take your medicine regularly. 
  
  

Benefits of taking anti-seizure medicines

• Reducing or stopping your seizures so they don’t interfere with your day-to-day life. Up to 70% (7 in 10) of people with epilepsy could have their seizures completely controlled with anti-seizure medications.
• Reducing the chance of accidents or injuries that can happen when you have a seizure.
• Reducing your worry that you’ll have a seizure.
• Reducing the chance of getting status epilepticus. This is when you have seizures that continue without stopping, or a series of seizures that happen for 30 minutes without you recovering in between. This can happen with any seizure type.
• Reducing the chance of SUDEP (sudden unexplained death in epilepsy patients). Read more about SUDEP(external link).

Anti-seizure medications (ASM) are usually available as tablets, capsules and liquids. If you find taking tablets difficult, ask your doctor to prescribe you something easier to swallow – some tablets can be chewed or crushed.     

ASM is usually taken once or twice each day. Sometimes it's taken 3 times a day. It’s important to take it regularly, as prescribed by your healthcare provider, because missing a dose can increase the risk of having a seizure. Read more about tips for remembering to take medicine.

Once you're taking anti-seizure medication, it’s a good idea to get advice about what to do if you ever forget to take it. The advice your healthcare provider gives you when you miss a dose will depend on which epilepsy medicine you're taking, and how many times a day you take it.

Anti-seizure medicines don't cure epilepsy, but they can stop the seizures from happening. For some people, having epilepsy is a lifelong condition and they will need to continue taking medication.

If you haven't had a seizure for 2 or more years, you may want to discuss coming off your treatment with your doctor. It will depend on several things, including the possible impact of seizures returning.  

Coming off ASM

When coming off anti-seizure medication, it's important to do it slowly. Stopping treatment suddenly is dangerous – it can cause seizures to start again, or happen more often and last longer than before.

You can plan with your doctor:

• how to come off the medication slowly
• what to do if your seizures start again.

If seizures do start again and you go back on medication, you may have to start at a low dose again until your body gets use to it. Always talk to your healthcare provider before re-starting anti-seizure medication.