Epilepsy Tips on Deciding the Right Treatment

The main form of treatment for epilepsy is drugs, but putting people on to long-term medication is not to be undertaken lightly.

This said, some doctors believe that treatment for epilepsy should be started sooner rather than later because it achieves better seizure control, lowers the risk of recurrence if you later come off your drugs, and makes for a better prognosis generally. There is some evidence to show that starting treatment early has some beneficial effect on the course of the epilepsy itself - i.e., it doesn't just stop seizures but may impact on the underlying cause and general brain health - while delaying treatment may make epilepsy worse, and make control harder to achieve later on.

Not all doctors agree. Some question the use of routine prescribing on the grounds that it is not proven that early treatment affects the course of the epilepsy. According to this point of view, epilepsy is a group of conditions, in which responses to drugs will differ. Also, prognosis depends on various unchangeable factors, such as the type of epilepsy, and the age at which it started, which will not be affected by early treatment. Some clinical trials comparing early treatment with deferred treatment did not seem to show any great benefit to earlier treatment. Some studies have shown that epilepsy sometimes seems to remit or stop spontaneously without treatment. For example, an American study of 204 patients reported in the New England Journal of Medicine found that only a third of patients who have a single seizure are likely to have any more seizures.

However, this is largely an academic argument, to be thrashed out at consultant level in medical journals; in practice, most doctors would agree that treatment should be started after two tonic-clonic seizures.

Anti-epileptic or anticonvulsant drugs control seizures in up to 80 per cent of all people with epilepsy. In up to 70 per cent, this will be with one drug - monotherapy, which is obviously preferred by both doctors and patients as being simpler and with fewer potential side effects. In around another 10 per cent of people, seizures will be controlled by a combination of two drugs. In the remaining people, seizures will be harder to control, and may involve trial and error with different drugs at different dosages.

Curiously, it isn't known exactly how many of the established anti-epileptic drugs work, but they are thought to slow down the tendency of brain cells to fire, or to alter brain chemicals so as to achieve a better balance of electrical activity or stop seizure activity spreading.

Once the decision to treat has been made, your doctor will decide on the drug of first choice, basing the decision on the type of seizures in questions and balancing how well the drug works (efficacy) against possible side effects.

The ideal aim of drugs is to control seizures with minimal side effects, and doctors usually start at a lower dose and build up, to avoid side effects as much as possible. Regular monitoring assesses the effect of medication, and occasionally with some drugs your doctor may perform blood tests to check drug levels.