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QUESTIONS ABOUT ANTI-EPILEPTIC MEDICATION

Anti-epileptic medication is used to prevent seizures from occurring rather than treating them when they have happened. It is therefore necessary to take medications regularly and consistently. In order to prevent further seizures from happening it may be necessary to take medication for long periods, sometimes many years.

There are a large number of different anti-epileptic drugs and they are effective for different types of seizures. The doctor will choose the most effective drug for an individual's seizure type or types. The current anti-epileptic drugs are listed in the page Drug Treatment of Epilepsy, which is available from the CIEN at the address overleaf.

What happens when I start medication?

When somebody starts taking anti-epileptic medication, the drugs are usually introduced gradually, and the dose increased slowly until it is at a level where it is either controlling the seizures or the person starts to experience side-effects. If the drug does not control the seizures, or if the side-effects are unacceptable another drug might be tried. Most people will have their seizures controlled by one anti-epileptic drug (monotherapy). For a small number of people, however, it may be necessary to take more than one type of anti-epileptic drug (polytherapy) in order to control the seizures.

When can I stop taking medication?

If somebody has not had a seizure for two or more years, the doctor may suggest coming off the medication. When stopping medication the dose must be reduced slowly and always under medical supervision. There can be risks in stopping treatment suddenly as it can lead to frequent and sometimes prolonged seizures. This is true even if the medication was not successful at controlling the seizures. The consequences of a recurrence of seizures, such as the loss of driving licence and the employment situation, are usually discussed before withdrawing treatment. If seizures do reoccur, recent evidence suggests that recommencing the previous treatment immediately will usually result in the same level of control as before. It should be borne in mind, however, that in rare instances the original anti-epileptic medication may prove to be no longer effective in controlling the seizures, even when it had previously been successful.

Most people do not experience any withdrawal symptoms providing the drug is withdrawn slowly as the doctor directs. Anti- epileptic drugs that may result in withdrawal symptoms include the benzodiazepines: diazepam (Valium), clonazepam (Rivotril) and clobazam (Frisium). The symptoms may include feelings of anxiety and panic, restlessness, sweating and an increase in seizures.

What about side-ffects?

All drugs, including anti-epileptic medication, have the potential to cause side-effects. This does not mean that everybody taking a particular drug will experience them. Side-effects can be divided into three main categories:

Allergic reactions: these are rare and occur because an individual is sensitive to the drug. They often take the form of an itchy skin rash and usually occur soon after treatment is started. If you think you are experiencing, an allergic reaction it is important to seek medical advice.

Dose-related effects: these are the more common type of side- effect and usually occur when the dose of the drug being taken is too high for that individual. If the dose is reduced, or the schedule for taking the drug is altered, the side-effects should disappear. The most common side-effect is a feeling of drunkenness, but people can also experience drowsiness, dizziness, unsteadiness, poor concentration and memory and slurred speech.

Long term (chronic) effects: these are also rare, and can occur if somebody has been taking a drug over a long period of time. It tends to affect people more if they are taking a combination of drugs rather than just one. Side-effects could include swelling of gums, acne and weight gain. As with the dose- related effects, reducing the dose, or altering the medication can often alleviate these symptoms.

Will the anti-epileptic medication interact with any other medication I may have to take?

Other medication can interact with anti-epileptic drugs. It is therefore important to check before taking any other medication either prescribed or over the counter treatments. It may be a good idea to have your prescription dispensed from the same pharmacist whenever possible. Some anti-epileptic drugs make certain other drugs less effective. The contraceptive pill is an example of this, so some women with epilepsy may need to use a higher dose pill if they are taking anti-epileptic medication. Breakthrough bleeding can be a sign that the dose of the pill is not high enough and that it will not be providing adequate contraceptive protection. (There is further information in the leaflet Women and Epilepsy, available from the CIEN)

Is it OK to drink alcohol?

Some people with epilepsy prefer to drink no alcohol at all if they are taking anti-epileptic medication. There is an interaction between anti-epileptic drugs and alcohol, but this should not cause a problem when alcohol is taken in moderation.

What about other recreational drugs?

Amphetamines, ecstasy, cocaine and heroin have all been associated with seizures in people without epilepsy. These drugs have also been shown to increase the frequency of seizures in people with epilepsy. Modest doses of cannabis are probably not harmful. There is a suggestion, however, that withdrawal of cannabis may result in worsening of seizures. There are also social and legal implications of using illicit recreational drugs also need to be considered.

What if I forget to take my anti-epileptic medication?

It is important that the medication taken for epilepsy is taken regularly and as prescribed by the doctor. However, missing a single dose on a rare occasion is unlikely to be dangerous and result in seizures. A drug wallet can help if remembering to take your medication is a problem.

The majority of people with epilepsy do not experience seizures once the appropriate anti-epileptic drug treatment has been found. This can take time to achieve. In some people it may not be possible to control their seizures completely. Others may choose not to take anti-epileptic medication if their seizures are very infrequent.

People with epilepsy who are experiencing seizures, and those who have contact with them in their daily lives, generally tend to feel more comfortable with the condition if they are well- informed about epilepsy. Knowing what is likely to happen when a seizure occurs, and how the person with epilepsy can be assisted during and after a seizure can reduce anxiety.

Are all epileptic seizures the same?

There are many different kinds of epileptic seizures and the action required during and after a seizure will depend on the seizure type. Some people may experience more than one kind of seizure. (Seizure types are explained in more detail in the CIEN �Seizures� page). Some people only experience seizures when they are asleep. The following procedures also apply to sleep seizures.

What do I need to know about somebody's epilepsy?

Knowing the answers to the following questions will enable you to help someone during a seizure and to pass on the relevant information to medical personnel if necessary.

	What type of seizures does the person have?
	How long do their seizures normally last?
Epileptic seizures usually stop of their own accord and last a similar length of time on each occasion.
	Does the person have a history of status epilepticus? When a seizure does not stop naturally, or one seizure follows another with no recovery in between, it is known as status epilepticus and medical attention will be required.
	How long does it take for the person to fully recover following a seizure?

Some people may appear to be fully recovered but will need to be accompanied for a while for their safety.

	How frequent are the seizures?
	Are there any triggers for the seizures?
	What medications are they taking?

All this information can be recorded on an ID card available from the CIEN.

How to manage a convulsive Epileptic Seizure?

Most seizures happen without warning, last only a short time and stop without any special treatment. Injuries can occur, but most people do not come to any harm in a seizure, and do not usually need to go to hospital or see a doctor. When a person has a convulsive seizure, it is possible that their regular breathing pattern will be interrupted and their colour may turn be blue. Although this can be frightening to witnesses, it does not usually mean it is a medical emergency. (This is explained in more detail below).

What to do during a convulsive seizure?

Prevent others from crowding around.

Put something soft under the person's head (like a towel / sheet) to prevent injury.

Only move if they are in a dangerous place, e.g. in the road, on top of stairs.

Do not attempt to restrain the convulsive movements. Allow the seizure to take its course.

Do not put anything in the person's mouth. There is no danger of choking the tongue and teeth can easily be broken.

What to do when the seizure has stopped?

Roll the person, if possible, onto their side into the recovery position.

Wipe away any excess saliva and if breathing is still laboured, check that nothing is blocking the throat such as dentures or food.

Do all you can to minimise embarrassment. If the person has been incontinent, deal with this as privately as possible.

Stay with the person, giving reassurance, until they have fully recovered.

Common Injuries

Shoulder dislocation

Fractures

Biting of tongue

Status Epilepticus

What is Status Epilepticus?

Seizures lasting for more than 30 minutes or repeated seizures between which the person does not regain consciousness. As the extent of damage increases with the length of attack, medical help should be sought as soon as possible (below 20 minutes) to stop the seizures.

It is a Medical Emergency and medical assistance should be sought if :

	Someone has injured themselves badly in a seizure.
	They have trouble breathing after a seizure.
	One seizure immediately follows another or the seizure lasts more than five minutes and you do not know how long they usually last.
	The seizure continues for longer than usual for that person.

Do the following

Call an ambulance

Transport the person to the nearby hospital or to the doctor already treating the person, if known.

Give the attending doctor a reliable account.

How to manage other seizure Types

These may include:

	Complex Partial Seizures:
	The persons become suddenly confused, wander around aimlessly or act as if they do not understand what they are doing (pick up objects, remove clothes, etc):
	Do not restrain, but guide away from danger, such as wandering into the road; speak gently and calmly to the person to help reorientation to surroundings as quickly as possible. The person may be confused for some time after the seizure and it is better to leave him/her alone than to keep offering help and have it rejected with what might be misunderstood as aggression.
	Simple Partial Seizures
	In these types of seizures, there is no loss of consciousness and the person is aware of what is happening to him/her. However, the seizure effects can be disturbing for the person experiencing them and reassurance and comfort may be appropriate. If this type of seizure is a warning (sometimes called an aura) that a convulsive seizure will follow, the person may need assistance in making himself/herself as safe as possible before it occurs.
	Tonic and Atonic Seizures
	The person falls and then recovers with or without confusion.
	Reassure, check for injury and stay with them until fully recovered.
	Absence Seizures (Previously known as Petit Mal)
	The person has a brief interruption of consciousness. This type of seizure is usually very brief, but the person may need to be guided away from danger.

How else can I help?

Due to loss of awareness or consciousness, people with epilepsy often do not know what happens to them during a seizure. Observers can provide vital information for the GP or neurologist which can be very helpful in making a diagnosis of epilepsy and what types of seizures are occurring, enabling the doctor to prescribe suitable anti-epileptic medication.

The following information may be helpful in this way:

	Keep a record of the dates and times that seizures occur. *
	Where was the person? What was he or she doing?
	Did the person mention any unusual sensations, such as odd smell or taste?
	Did you notice any mood change, such as excitement, anxiety or anger?
	What brought your attention to the seizures? (a noise such as a fall or body movements such as eyes rolling or head turning).
	Did the seizure occur without warning?
	Was there any loss of consciousness or altered awareness?
	Did the person's colour alter, (eg: pale, flushed or blue). If so, where - face, lips, hands?
	Did any parts of the body stiffen, jerk or twitch? If so which parts were affected?
	Did the person's breathing alter?
	Did the person perform any actions, eg. mumble, wander about, fumble with clothing?
	How long did the seizure last?
	Was the person incontinent?
	Did he/she bite his/her tongue?
	How was she/he after the seizure?
	Did he/she need to sleep? If so, for how long?
	How long was it before the person was able to resume his/her normal activities?
	Any other observations?

* Seizure Diaries in which to record seizure information can be obtained from the CIEN.