Drug Therapy
Many seizure disorders are controlled by various types of anti-seizure medications (sometimes called anti-convulsants or anti-seizure drugs [AEDs]). As well, different types of seizures require different medications. Many of the drugs may 7produce numerous adverse side effects. At least 20% of all patients with epilepsy have uncontrolled seizures and many suffer adverse side effects from anti-seizure drug(s). Therefore, there is a need to develop new drugs. Epilepsy medication may be prescribed alone or in combination. If a person has more than one type of seizure, s/he may have to take more than one type of drug to gain control. However, physicians try to control seizures with a single medicine if they can. In the majority of countries, between ten to twenty drugs are currently approved for the treatment of epilepsy.
When to Start Anti-Seizure Drugs
It is essential that, before anti-seizure drug therapy is started, a correct diagnosis is made. A clear distinction between epileptic and non-epileptic attacks is important because the label of “epilepsy” has crucial medical, therapeutic and social implications (Laidlaw et al., 1993, p. 523). The variable prognosis of epilepsy makes it difficult to decide when to start drug treatment in the individual patient or when to stop. The decision to start treatment in an individual patient should take into account not only the number of attacks experienced, but also the circumstances in which they occurred, the presence or absence of precipitating factors, the type and severity of the attacks, whether or not there are any accompanying neurological, psychiatric or social problems, and whether the patient wants treatment (Laidlaw et al., 1993, p. 424). The risk of reoccurrence of a seizure is greater after two seizures than after one. Drug therapy offers symptomatic benefit, but it has yet to be proved that it achieves more than this.
Resistance to Medication
Approximately
- 50% of seizures are eliminated by medication,
- 30% of seizures are reduced in intensity and frequency by medication,
- 20% of seizures are resistant to medication.
Reaction to a given drug varies from one person to the next. Medication that works for one person with epilepsy will not necessarily work for another. Also, some drugs will reach a therapeutic, seizure-preventing level in a patient’s bloodstream more quickly than other drugs. For these reasons, it may take some time to customize the dosage and/or choice of drug(s).
Blood Level Monitoring
Anticonvulsant drug level testing can help a physician achieve seizure control by monitoring the presence of a medication in a patient’s bloodstream.
The bloodstream is the pathway to the brain, that leads medication to the centers of the brain where seizures begin. If a drug’s blood level is too low, seizures may occur and the dosage will have to be increased. Conversely, too high a drug level may cause a patient to experience side effects, such as drowsiness or confusion. This necessitates a reduction in the dosage or, possibly, a change to a different medication.
Generally, drug level testing should be performed during the course of a treatment program. Subsequent tests are carried out if there are changes in control, or if side effects occur.
History of Medications
For over 100 years, various kinds of medications have been used to treat seizure disorders.
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