About seizure medications
Seizure medications are used to control seizures in people with epilepsy. Epilepsy is a neurological disorder that involves recurrent seizures caused by abnormal brain activity.
Seizure medications are most frequently administered in pill form that should be taken at the same time every day. However, some seizure medications are available as a liquid, suppository or intravenous injection.
Most seizure medications control seizures by slowing down or stopping neuronal excitability in certain parts of the brain. This reduces the risk of neurons firing uncontrollably, which causes seizures. In some cases, seizure medications are used to treat other conditions such as neuropathy and certain mental health problems, although how it works to treat these conditions is not completely understood.
For people with epilepsy, the goal of seizure medications is to reduce the frequency of seizures as much as possible with the fewest adverse side effects. This is usually achieved by starting the patient on a low dose of seizure medication and slowly increasing the dosage until seizures are controlled. A physician will select the most suitable seizure medication for a person with epilepsy based on the type of seizures experienced, the results of certain diagnostic tests (e.g., electroencephalogram) and the patient’s history with similar medications. In some cases, patients may have to switch medications two or three times before they find one that controls their seizures with minimal adverse side effects. Some people may need to take more than one medication to control their seizures. The use of multiple medications is called polytherapy, as opposed to monotherapy, in which a single seizure medication is used.
Types and differences of seizure medications
There are numerous types of seizure medications, each of which may be used to treat different seizure conditions.
People with epilepsy may initially be prescribed a first-line medication. These are medications that are the first choice of physicians to treat seizures. In some cases, people may be required to take other medications in addition to these first-line drugs. These additional medications are called add-ons or second-line therapy. Other medications may also be used on a temporary basis. Some medications are available in extended release (XR) formulations, which help to maintain a steady level of the medication in a patient’s body.
Some of the most common seizure medications and their brand names include:
First-line treatments Generic Name Brand Name
Carbatrol, Tegretol, Tegretol-XR
Add-on treatments Generic Name Brand Name
Other medications Generic Name Brand Name
Generic substitution of seizure medications can be problematic and may result in breakthrough seizures. Patients should not make a generic substitution without first consulting their physician.
Conditions treated with seizure medications
Seizure medications are prescribed for a variety of conditions, including:
EpilepsyEpilepsy involves experiencing recurrent (two or more) unprovoked seizures. These seizures occur when the neurons (nerve cells) in the brain become disturbed and suddenly increase their activity, causing an electrical storm that can overwhelm the brain. This can result in various symptoms, ranging from slight changes in taste, smell or behavior to a loss of consciousness and whole body convulsions. Seizure medications can control the parts of the brain that are causing the seizures.
Cerebral palsyCerebral palsy (CP) is a neurological disorder that affects body movement and muscle coordination. The condition can appear in infancy and early childhood but is most often present at birth. It is caused by abnormal brain activity, which may result in seizures. Although it cannot be cured, the seizures can be controlled with seizure medications.
Muscular dystrophyMuscular dystrophy refers to a group of diseases that cause muscles throughout the body to deteriorate. The diseases result from genetic mutations. Symptoms include muscle spasms, which occur as muscles break down and are reduced to fatty tissue. Muscle spasms in muscular dystrophy can sometimes be treated with seizure medications.
Pain syndromesStudies have shown that seizure medications can be useful for the control of certain types of nerve pain, particularly the shooting or stabbing pain associated with trigeminal neuralgia, peripheral neuropathy, migraines and cluster headaches. Although it is not completely understood exactly how seizure medications control nerve pain, it is thought that they may block pain signals from traveling to the brain. Because of the risk of adverse side effects, seizure medications are often used only as a last resort for people with uncontrollable nerve pain. It is important that people who are considering using seizure medications to control their nerve pain only do so under the supervision of a physician.
Certain mental health conditionsSome seizure medications are used to treat mental health disorders such as bipolar disorder (also known as manic-depressive disorder), certain personality disorders and sleep disorders. It is not completely understood how seizure medications help to treat these conditions, although it is thought to be related to their ability to inhibit abnormal neuron activity in the brain.
Conditions of concern
Patients are advised to consult their physician about whether seizure medications are appropriate for them if they have been diagnosed with any of the following conditions:
- High blood pressure
- Heart disease
- Kidney disease
- Allergies to components of seizure medications
- Side effects
Potential side effects of seizure medications
Common side effects of seizure medications may include:
The following seizure medications may have additional side effects, including:
Drug Side Effect(s)
adrenocorticotropic hormone (ACTH)
High blood pressure
Increased appetite and weight gain
Temporary hair loss
Loss of appetite
Slow motor speed
Gum overgrowth (gingival hyperplasia)
Excessive hair growth
Coarsening of facial features
Reduced blood counts
Loss of appetite
Increased risk of infection
Swelling of hands and feet
Hyperactivity in children
Cognitive, speech and language problems
Tingling in face and extremities
Acute angle glaucoma
Drug or other interactions
Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal remedies. Of particular concern to individuals taking seizure medications are:
- Other seizure medications. Most seizure medications interact with other seizure medications. This may decrease the effectiveness of either (or both) medications or produce severe side effects. For people undergoing polytherapy (treating epilepsy with more than one seizure medication) it is important that any side effects or increase in number of seizures are reported to a physician.
- Alcohol. Drinking alcohol is not recommended for people who are taking seizure medications to control seizures. Alcohol can increase the likelihood of experiencing certain side effects such as dizziness and drowsiness. Alcohol can also decrease the effectiveness of many seizure medications, and increase the risk of having a seizure.
- Oral contraceptives. Many seizure medications adversely interact with oral contraceptives and may reduce the effectiveness of both. Women who are taking oral contraceptives are advised to discuss alternative contraceptive methods with their physician.
- Antidepressants. People who take antidepressants should consult with their physician about which seizure medications to take. Some antidepressants can reduce the effectiveness of certain seizure medications (e.g., carbamazepine, phenytoin, phenobarbital).
- Grapefruit juice. Grapefruit juice interferes with the liver’s ability to rid the body of some substances. This could cause seizure medications to build up to toxic levels in the body. While the buildup is less likely if the juice is ingested four or more hours prior to the medication, patients taking seizure medications are advised to refrain from drinking grapefruit juice at all. There is no indication that eating grapefruit (as opposed to drinking juice) presents any risk of adverse effects to patients.
The seizure medication carbamazepine interacts with certain antibiotics (e.g., erythromycin) by raising the levels of carbamazepine in the blood. The seizure medication phenytoin is known to interact with a wide variety of medications including antibiotics, ibuprofen, lithium and corticosteroids.
Additionally, some seizure medications can interact with certain vitamins and herbal medications, decreasing the effectiveness of the seizure medication. Patients are advised to consult their physician regarding supplements and interactions with their seizure medication.
Livestyle considerations with seizure medications
Taking seizure medications as prescribed is one of the most important lifestyle considerations for patients with epilepsy. It is believed that 15 percent of patients with epilepsy do not take their medications as instructed, according to the Epilepsy Foundation. This can significantly increase the risk of more severe and unmanageable seizures.
Using memory aids such as a pill reminder box or calendar can help patients comply with their medication schedule. Watch alarms and other reminder devices may also help.
- How to use
Pregnancy use issues with seizure medications
The safety of most seizure medications during pregnancy has not been established and it is important that women who are taking seizure medications consult with their physician before they attempt to get pregnant.
Women with epilepsy have a slightly higher risk (4 to 6 percent) of having a child with a birth defect than women without epilepsy (2 to 3 percent), according to the Epilepsy Foundation. This risk increases when pregnant women take certain seizure medications. The most common birth defects associated with seizure medications are spina bifida and cleft palate formation. The American Academy of Neurology recommends that women with epilepsy of childbearing age should take no less than 0.4 milligrams per day of folic acid and continue this during pregnancy.
A physician may recommend that women modify their dosage level or taper off their medications before they become pregnant to reduce the risk of birth defects. If seizure medication withdrawal is planned, it should be done at least six months before conception. If medication withdrawal is not possible, therapy should be optimized before conception. During pregnancy, it is not recommended to switch to another anti-seizure medication for the sole purpose of avoiding birth defects. Women with epilepsy are advised to follow up regularly with their neurologist during pregnancy.
Some seizure medications may be passed to infants through breast milk. Women who are taking seizure medications may be advised by their physician to refrain from nursing or to wait several hours after taking their medications before nursing. It is important to discuss medication management with a physician before, during and after pregnancy.
Child use issues
Because of the tendency of children to experience seizures as a result of a high fever, seizure medications are not usually recommended for children who have an isolated seizure. However, children who have epilepsy will usually be prescribed seizure medications.
There are differences in the way children and adults are prescribed seizure medications. For example, children may be prescribed larger doses of seizure medications than adults because of the way children’s bodies process the drugs. Also, dosage levels for children are changed regularly because of the rapid growth their bodies undergo as they mature. This may require regular consultations with the child's physician to assess the effectiveness of the current seizure medications.
It is important that children learn to take responsibility for their seizure medications. Although parents or guardians should monitor the child’s compliance, children who understand when and why they must take their medications are less likely to stop taking their seizure medications.
Some parents worry that children may become addicted to their seizure medication, although there is no evidence that this occurs. Also, nothing indicates that children who take seizure medications are more likely to abuse medications or take illegal drugs.
Elderly use issues
Seizure medications may not pass as quickly (metabolize) through the bodies of elderly patients as they do in younger patients. As a result, elderly people may be especially likely to experience certain side effects associated with seizure medications, including confusion, unsteadiness or fatigue.
Additionally, elderly people are more likely to be taking other medications that may adversely interact with seizure medications or they may have medical conditions that can affect the way seizure medications are absorbed. This is especially true in the case of diabetes, heart failure or kidney failure.
Symptoms of seizure medication overdose
In the case of seizure medications, there are several warning signs that may indicate a patient’s medication level is becoming toxic to them.
Patients exhibiting any of these signs or symptoms should contact their physician immediately:
Questions for your doctorPatients may wish to ask their doctor the following questions related to seizure medications:
- Should I be taking medications to control my seizures?
- Which seizure medications do you recommend?
- Can seizure medications be used to treat other medical conditions I may have?
- What should I do if I experience any side effects from these medications?
- Will I have to take seizure medications forever?
- Will these medications prevent me from having seizures?
- What should I do if I have a seizure while on this medication?
- What should I do if I forget to take a dose?
- Can I become addicted to these medications?
- Will these medications adversely interact with any of my other medications?
- Are there any over-the-counter medications I should avoid while taking seizure medications?
- Can taking seizure medications for pain relief cause seizures?