The treatment approach is to recognize and define seizures and then try to eliminate them. Again, where epilepsy does not exist and the seizures are due to low blood sugar, for example, the treatment may be blood sugar control. Medications for epilepsy can stop seizures without side effects.
Two or three medicines may need to be tried before the right one is found, but generally the most successful drugs are tried first. Two-thirds of patients will attain seizure freedom with only nuisance side effects. All seizures should be stopped, including the warning sensations that are called auras, whenever possible. Auras can be tolerated if they don't inhibit the person from daily responsibilities, but they may increase the chance of future seizures that are more serious.
Picking the medication to treat the seizures is a matter of several issues. First, does it work? Most epilepsy medications stop seizures in 1/3 to 1/2 of patients as their first treatment. Safety or the risk of serious side effects is a consideration. Fortunately, most of the medications don't have serious risk issues. The effect on bone marrow, kidney, liver or brain can in a few drugs create concern. Again, these are infrequent, occurring in 1 of 10,000 or more patients.
Probably the most important issue is side effects. It might be said that medications are helpful poisons and we separate them from other poisons because they produce more desirable effects than undesirable effects. Side effects, or the negative effects of the medication, are what keep patients from reaching the higher doses that produce seizure freedom. The side effects are very individual because of the person's perception of what is a concern.
Each drug will have common side effects such as fatigue, tiredness, dizziness and unsteadiness. Each medication may also have some unique side effects and those effects are how patients determine what they would prefer to take. Weight gain or loss, behavior changes, gum swelling, rashes or thinking problems are some of the issues patients must deal with.
The patient and physician must review the available medication choices and pick the one that is most suitable to the individual's lifestyle. The newer medications tend to have fewer of these side effects and can even have beneficial side effects. These might include weight loss or reduction in symptoms of illnesses such as migraine headaches or depression.
The final issue that must be addressed is what may be called "ease-of-use." Ease-of-use is a combination of the qualities of the drug, its preparations and how it's given. Qualities such as the breakdown of the medicine, problems with combining it with other medicines, and its ability to be started quickly can effect the ease-of-use. Preparations such as the pill size, elixirs and intravenous forms all affect the ability to continue and give treatment easily. How often a drug must be taken each day can affect the success of a drug's treatment. Where epilepsy medications are concerned, effectiveness, safety, side effects and ease-of-use must be considered to make the best choice.
How long does one treat seizures?
Often it seems that no one mentions the end of therapy, but many people can eventually discontinue medications. Seizures that stop for a period of two years can be gone, in remission, and the medication may be stopped. This is the goal most patients desire and one of the reasons they should carefully take all medications as prescribed. The absence of obvious brain damage in the medical history, physical examination, MRI and EEG results help determine the likelihood that medications will be successful and may be one day discontinued. But all of these thoughts start with seizure freedom for at least two years.