Medicines for epilepsy — use, side-effects, overdose and interactions

70% of patients with epileptic seizures can be treated well with medications, if used properly. Here's are the guidelines you need to know

By: Shraddha Rupavate | | Updated: March 24, 2015 5:11 pm

Despite increasing awareness about epilepsy, 90% of people who suffer from the condition still have to face discrimination by the society, says Dr Sudhir Kumar, senior consultant neurologist. ‘Even today, women with epilepsy face issues while getting married because most families, including those who are well-educated, reject them as soon as they learn about the condition,’ he says. Also Read - Young adults more likely to die from epilepsy: Here’s how you can help someone having a seizure

Probably, because of the disturbing characteristics of epileptic seizures, the belief that people with epilepsy are mentally challenged and cannot lead a normal life exists till date. Dr Sudhir emphasizes the fact that epilepsy is not a mental illness and people with the problem can live a normal life, get married and have children just like everyone else. Although we are still far from finding a cure for the disease, with appropriate medications and care, epileptic seizures can controlled without any interference between a person’s daily activities. Also Read - Neurons help in reducing seizures in newborns: Study

When are medicines for epilepsy prescribed? Also Read - Acute Encephalitis Syndrome kills 53 kids in north Bihar

Epilepsy is a chronic condition involving the brain. It is also called seizure disorder because of the characteristic recurrence of seizures that occur when the normal signaling to and from the brain gets disturbed. This has a direct effect on the consciousness, normal body movements and sensations of patients for a short span until the signaling mechanism reverts to normal.

‘A person who has suffered an epileptic seizure for the first time is generally not prescribed anti-epileptic medicines,’ says Dr Sudhir. ‘In case the patient leads a very active lifestyle that requires him to travel and work, we prescribe medicines to prevent recurring episodes. But otherwise with subsequent seizure or a second episode the patient needs medication to control seizures,’ he adds further.

What are the common drugs for epilepsy? How do they work?

Common drugs that are prescribed include phenytoin, valproate, phenobarbitone, oxcarbazepine and carbamazepine. These drugs can also be given in combination if a single drug (monotherapy) is ineffective for reducing seizures.

Most anti-epileptic drugs interact with certain receptors for chemicals in the brain called neurotransmitters or with channels that facilitate transmission of signals from the brain. Older drugs like phenytoin and carbamazepine reduce the hyperactivity of brain signals that lead to seizures. But the mechanism of newer drugs is not fully understood.

Are these medicines required life-long?

‘Well, epilepsy can’t be cured as of now. Medicines for epilepsy are prescribed to control episodes of seizures. About 70% of patients don’t need to take medicines after 3-5 years of therapy because the frequency of seizures gets reduced drastically. The patient is gradually taken off medication. But a few patients, about 30% of them, will have a relapse once they stop taking the medicines. Such people need to take the drugs life-long.

What is the required dosage of these drugs?

Anti-epileptic drugs are available in varying dosages. Usually 100-200 mg tablet is given in 1-2 doses daily, on an average. For children a lower dose 1-10 mg/kg may be prescribed.

Side-effects of these drugs is dose-dependent. General side-effects include:

Vision problems
Fatigue
Sleepiness
Stomach upset

What happens if the patient fails to take a dose?

‘See, these drugs have a long half life, which means they have the ability to stay in the body for a long time. So, patients should not panic if they miss to take one single dose. They can still resume to their prescription going forward. But this doesn’t mean that you can miss the dose every time because if you stop taking the medicine for a few days in a row then the chances of seizure increase. This especially happens with people when they fail to take their medicines along on a vacation. In such cases, instead of taking the medicines, patients should go to the clinic and get an intravenous injection from the doctor because oral medicines do not reach their maximum efficacy as soon as they are taken,’ explains Dr Sudhir.

What happens when extra dose is taken? Is it harmful?

‘All drugs have a therapeutic window in which they elicit a therapeutic response without causing side-effects. For antiepileptic drugs the therapeutic window is such that slight overdose will not cause any harm or side-effects. So instead of 2 tablets that are prescribed, even if you take 4, nothing will happen. But taking more than that can result in complications, especially with drugs like phenytoin that have a narrow therapeutic window. It can result in cardiac complications that create an emergency situation. Generally overdose in epilepsy is found only in people with suicidal tendencies who may consume 20-30 tablets together,’ says Dr Sudhir.

What precautions should people take while on medication?

According to Dr Sudhir, patients with heart disease and diabetes taking medicines for epilepsy should inform the doctor about the drugs they are taking as they may interact with antiepileptic drugs. ‘The doctor will adjust the dose and dosage pattern depending on your condition, to avoid interactions and adverse events. For example, phenytoin may cause increase in blood sugar levels in diabetic patients and newer drugs may reduce kidney function and affect the heart in patients with heart disease and kidney disease,’ he says.

Do patients need to modify their diet?

‘Not necessarily. Epilepsy patients can eat anything but they should remember eating meals on time because fasting for a long time can result in hypoglycemia that can affect the brain.’

Read more about causes, symptoms, diagnosis and treatment of epilepsy.

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Published : May 2, 2014 3:05 pm | Updated:March 24, 2015 5:11 pm

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