Drug therapy is the most common treatment for epilepsy and is usually tried first. Up to 60 per cent of people with epilepsy can control their seizures using medications. The goal of drug treatment is to obtain the best possible seizure control with the fewest side effects. In most countries, between 10 to 20 drugs are currently approved for the treatment of epilepsy.

Medications that prevent seizures may be prescribed alone or in combination. Many anti-seizure drugs can be used to treat a range of different types of seizures, while other drugs are used for specific seizure types.

Providing a good description of your seizures to your healthcare provider can help them diagnose your seizure type and determine the best drug treatment for your epilepsy disorder. Keeping a seizure diary can also help you and your healthcare provider determine how well your medication is working.

To be effective, a constant level of the prescribed medication must be in the blood. The dosage depends on the frequency of seizures, type of seizures, individual tolerance and other factors. Drugs do not cure epilepsy. They only control it.

While many people obtain good control their seizure disorder with anti-seizure medications [also known as anticonvulsants or anti-epileptic drugs (AEDs)], at least 20 per cent of people with epilepsy continue to have uncontrolled seizures despite taking one or more AEDs. It may take a long time to determine the right medication and dosage.

Many people with epilepsy experience adverse side effects from their medication. There is a need for more research and development of new medications to treat epilepsy so that people can achieve good seizure control without any significant side effects.

Before starting any anti-seizure drug therapy, it is essential that people obtain a correct diagnosis from their physician. A clear distinction between epileptic and non-epileptic episodes 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 or stop drug treatment in the individual. A person with epilepsy should take into account:

• the number of episodes experienced,
• the circumstances in which they occurred,
• the presence or absence of precipitating factors,
• the type and severity of the seizures,
• whether or not there are any accompanying neurological, psychiatric or social problems, and
• whether the person wants treatment (Laidlaw et al., 1993, p. 424).

There is a greater risk of recurring seizures after two seizures than after one. Drug therapy offers symptomatic benefit, but it has yet to be proven that it achieves more than this. Anti-epileptic medication is meant to prevent the generation of seizures. It is important for people with epilepsy to obtain the best seizure control possible to reduce their risk of injury, accidents and Sudden Unexplained Death in Epilepsy (SUDEP).

Some types of non-epileptic seizures are initially difficult to diagnose. It is only after starting drug treatment without any benefits that physicians can make the diagnosis.

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• Medication is effective for seizure control in about 50 per cent of people with epilepsy.
• An additional 30 per cent of people with epilepsy can obtain some degree of control over their seizures (reduced severity and frequency) with medication.
• Approximately 20 per cent of people with epilepsy will continue to experience uncontrolled seizures despite drug therapy.

Each person reacts differently to any given drug. Medication that works for one person with epilepsy will not necessarily work for another. Some drugs will reach a therapeutic, seizure-preventing level in the person’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) and find the treatment that is right for each person.

Anticonvulsant drug level testing can help a physician control a person’s seizures by monitoring the presence of a medication in the bloodstream. The bloodstream is the pathway that leads medication to the parts of the brain where seizures begin.

If a  blood test shows a drug level that is too low, seizures may occur as the person requires a higher dosage. On the flip side, a drug level that is too high may cause a person to experience side effects such as drowsiness or confusion. In this case, the physician may recommend reducing the dosage or possibly switching to a different medication.

Generally, physicians should perform drug level testing during the course of a treatment program. Subsequent tests are required if there are changes in seizure control or if side effects occur.