Finding your right epilepsy medication can be trial and error

May 9, 2013

Finding a patient’s correct epilepsy medication and dosage can be a matter of trial and error for doctors, but there are things people living with seizure disorders can do to assist in the process.

Dr. Peter Carlen
Dr. Peter Carlen

The first challenge for doctors is often making the right diagnosis, says Dr. Peter Carlen, a neurologist at Toronto Western Hospital’s Krembil Neuroscience Centre.

Different types of epilepsy respond differently to medications, says Carlen. For example, primary generalized epilepsy, is made worse by certain anticonvulsants, such as Tegretol.

However, secondary generalized seizures, which begin as partial seizures that evolve into generalized seizures, typically respond well to most anticonvulsants.

In the process of determining if a person should even be on a medication it’s important to rule out emotional seizures, or seizures brought on by anger, fear or happiness, says Carlen. Medications typically don’t work in these cases.

“The first thing is to make the right diagnosis,” explains Carlen. “Even after you make the right diagnosis some patients still don’t respond, so you have to try different drugs.”

When a person with epilepsy continues having seizures after two or more antiepileptic medications have been taken during a one-year period, their seizures are categorized as “medically refractory,” according to the Ontario Health Technology Advisory Committee (OHTAC) epilepsy expert panel.

A free online tool, developed in Canada, can help physicians determine when it is appropriate to refer their patients for an evaluation at a comprehensive epilepsy centre.

For those people living with epilepsy who experience side effects from medication it’s important to make their doctor aware of the situation.

If side effects are severe, the medication needs to be cut back if possible, says Carlen.

“However, cutting back the drug could make seizures worse, so it’s a difficult problem with no easy answer,” he says.

Carlen also recommends that people with epilepsy who are experiencing possible medication side effects to keep a seizure diary to chart the frequency of seizures. Seizure diaries can be obtained from epilepsy agencies and from doctors.

“Epilepsy agencies also provide information and support to help people with epilepsy talk to their family and friends about epilepsy and seizures,” notes Epilepsy Ontario executive director Rozalyn Werner-Arcé.

It’s also important for people to engage family members and friends about their seizure disorder so they understand what a seizure looks like. Sometimes a person is having a seizure and they don’t know it, and making others aware of the condition can be helpful in determining seizure frequency, says Carlen.

While there can be challenges determining the correct medication and dosage to treat seizures, Carlen says he’s hopeful about the future possibilities of medical science.

“We don’t have the (technology) yet to take someone’s blood and say, ‘This will be the drug for you.’ We’re not there yet, but that should be the way of the future,” he says.

If you have feedback on this story, or have a story of your own that you would like to share, please contact the newsroom at 800-294-0051, ext. 23, or e-mail deron(at) You can also leave a comment below.

Writer: Deron Hamel

* If you wish to reprint this story, please include following notice: “This story originally appeared on the Epilepsy Ontario website.”

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