Anti-seizure medication

The decision about when to start medication involves many factors. For example:

• The number of seizures and their severity: 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 it's likely you'll have more. In this situation it may be a good idea to think about starting anti-seizure medication.
• Cause of the seizures: Seizures can also result from a stroke or traumatic brain injury (TBI). They may occur within 24 hours of the event or weeks, months, or even years later. Most seizures related to stroke or TBI tend to happen within the first 24 hours. However, research shows that the longer the gap between the initial injury and the first seizure, the higher the chance of developing epilepsy. When seizures begin months or years later, treatment with anti-seizure medication is usually recommended.
• Impact on your daily activities: If seizures affect your driving, employment, safety, or quality of life, medication may be started even after one seizure.

Assessing the benefits and risks of anti-seizure medication

The decision to start anti-seizure medicines (ASM) should be made by thinking about the risks and benefits of starting the medicine.

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).

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 types of seizure:

• 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 health conditions you may have
• 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 and anti-seizure medicines and pregnancy.

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

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

The aim of treatment is for you to be completely free of seizures.

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 harm to the baby if taken during pregnancy.

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

Sodium valproate and topiramate are not 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 it's 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're pregnant, make an urgent appointment with your doctor or nurse practitioner. They will refer you immediately to your specialist who will give you advice. 

If you can father children and you're taking sodium valproate

• Most anti-epileptic medications are safe in males. However, if you father a child while you're 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 to take during your pregnancy and when your baby arrives.
• There are many anti-seizure 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're 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)

Here are some tips to get the most from your anti-seizure medicines (ASM). This means getting the best seizure control with the fewest side effects.

• Timing: It’s important to take ASMs at set times each day for the best seizure control. Read more about tips for remembering to take medicine.
• Missed dose: Be prepared and know what to do if you forget to take a dose. You're more likely to forget a dose when you have a change from your regular routine, such as if you are on holiday. For most medicines, you can take your next dose at the usual time and at your usual dose. Do not take any more than you have been prescribed. 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.
• Refill your prescription early: Get your prescription before you run out of medicines. Make sure you have enough for weekends and holidays.
• Swallowing problems: ASMs are usually available as tablets, capsules and liquids. If you find taking capsules or tablets difficult, ask your doctor or nurse practitioner to prescribe you something easier to swallow – some tablets can be chewed or crushed.
• Switching brands: For some ASMs such as carbamazepine, phenytoin, phenobarbital and primidone, it is important to take the same brand each time to make sure you have good seizure control. If you notice your medicines look different, or if you are worried about this, talk to your pharmacist or healthcare provider.
• Keep an eye for any changes in your overall health or seizure patterns: After starting medication, it's important to monitor any changes in your overall health or seizure patterns. If the medicine isn't working well or causing side effects that bother you, let your doctor know straight away, as the dose or type of medication may need to be adjusted. It may take some time to find the medication that works best for you. In most cases, only one ASM is needed to prevent seizures, but some people may need 2 or more. When starting your ASM, your prescriber will start you on a lower dose and may increase it if this fails to prevent seizures.
• Taking other medicines: Other medicines, herbal supplements or rongoā Māori and can sometimes affect how well some ASMs works, so it's important to check with your healthcare before starting any new products.

Travelling with anti-seizure medicines

Having epilepsy should not stop you from travelling, both locally and internationally. Discuss your travel plans in advance with your healthcare provider. Ask for a medical letter which includes information about your diagnosis, medications, and emergency care instructions. Always carry extra medication (enough for at least a few days more than the length of your trip) and keep medication in original labelled containers. Carry medicines in your hand luggage in case checked bags are delayed or lost. If you're travelling across time zones, it may affect your dosing schedules – ask your healthcare provider how to manage this safely. 

Anti-seizure medications 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 prescriber. 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 prescriber:

• 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.

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 new 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. Contact your healthcare provider straight away if you notice any skin reactions, or yellowing eyes or skin.

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. It may take some time to find the medication that works best for you. In most cases, only 1 type of ASM is needed to prevent seizures, but some people may need 2 or more.

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