Once the diagnosis of epilepsy has been established, its treatment must be individualised. This includes the need for treatment and choice of Anti-Epileptic Drugs (AED).  The benefits of treatment (such as reducing the risk of seizure recurrences or injuries self and others) must be weighted against the drawbacks of treatment which include potential drug side effects, cost and inconvenience.  The choice of medication depends on several factors;

• Diagnosis of epilepsy
• Severity of seizures
• Level of function
• Occupation
• Family support
• Patient needs

Treatment goals

The aim of treatment is to prevent seizures from recurring or at least reduce the frequency of the seizures (efficacy) with minimal side effects (tolerability). 

With adequate treatment, over 70% of cases can have their seizures well controlled.  It is important that BOTH patients and caregivers are INFORMED about the nature of the disease, treatment goals, the risks and benefits of treatment, including the risks associated with poor compliance or sudden stopping  treatment.  They should also be taught what to do during a seizure attack.

Click to view Epilepsy Foundation America video on Epilepsy Treatment

1. Prophylactic Treatment is sometimes required in patients with severe head injuries to reduce the risk of early post-traumatic seizures (which can occur within the first week of injury). 

2. Long Term Treatment is recommended to treat patients if they have

• at least 2 seizures occurring more than 24 hours apart
• recurrent seizures
• a single seizure episode but with a high risk of recurrence (such as having abnormal EEG, underlying brain lesion, family history or nocturnal sleep seizures)

Drug Monitoring

Drug monitoring of serum AED levels may be required to;

• check medication compliance
• determine if signs or symptoms of side effects are the result of AED toxicity
• provide dosing guide for certain AEDs such as phenytoin
• provide treatment guidance during pregnancy or status epilepticus

Prognosis

Around 10-20% of patients have seizures which continue beyond 2-3 years.  Patients who are seizure free for more than 2 years may consider to have gradual medication withdrawal.  The decision to stop needs to be discussed with your doctor and to weigh the risks and benefits carefully.  However, there is NO guarantee of seizure freedom after medication withdrawal as there is still a 30-40% risk of relapse during the first year of cessation.  Epilepsy is considered to be RESOLVED in those who have remained seizure free for the last 10 years and with no seizure medicines for the last 5 years.

Discuss your treatment options with your neurologist

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