MEDICATION FOR EPILEPSY
The standard treatment for epilepsy is the regular use of one or more chemical substances called anti-epileptic or anti-convulsant drugs. The ideal situation is when a person takes as little medication as possible while maintaining seizure control.
Over the past decade there have been a number of developments, with new more specific drugs becoming available. This is not to say that the older drugs have become obsolete. On fact, the newer preparations may not be at all suitable for some people.
Each drug has two names, the generic, or chemical name (for example carbamazapine) and the trade name (for example Tegretol), given by the manufacturer. It is helpful for a person to know the generic names of his/her drugs, especially when traveling abroad.
Co-operation between you and your doctor is essential in establishing optimum control of your epilepsy. The more accurately you or a family member can describe your seizures and the effects of the medication, the more precise the doctor’s prescription can be. It is important that drugs are taken exactly as prescribed. Compliance is a major factor in the overall results that can be achieved. Your pharmacist is also able to assist with information and advice about your medication.
The table below contains information about the most commonly used anti-epileptic drugs. This is a summary and by no means is it a full description of the drugs.
In all cases it is essential to discuss your medication needs and queries with your doctor. Special consideration must be given in respect of drugs for children with epilepsy since the effects of the medication may differ from adults.
There are certain drugs that have proved to be harmful to the unborn child. It’s advisable for a woman to discuss her situation with her doctor prior to becoming pregnant so she can be informed of the risks that may exist and the options open to her.
When a person is on more than on type of medication, the drugs may influence each other and alter their effect. It is essential that the doctor should know about any other drugs a person with epilepsy is taking.
The interaction between oral contraceptives and anti-epileptic drugs (particularly carbanazapine, phenobarbitone and phenytoin) is such that the effectiveness of the contraception is reduced. Women with epilepsy should therefore obtain specific advice regarding contraception options. Alcohol taken with anti-epileptic drugs poses a problem and is best avoided. A balanced diet with adequate nutrients and daily water intake is advised for optimal drug absorption. More details - Click here
SUDDEN UNEXPECTED DEATH IN EPILEPSY (SUDEP).
SUDEP is Sudden Unexplained death in a person with Epilepsy who was otherwise well and in whom no other cause of death can be found despite thorough post mortem examination and blood tests. This definition excludes people dying in status epilepticus and those who drown. It has been estimated that the risk of sudden death is almost 24 times higher in people with epilepsy than for others. SUDEP is rare among people who have controlled seizures.
The cause of death in SUDEP is currently, by definition, unknown but various risk factors have been suggested. These include young adulthood, presence of convulsive attacks, poor seizure control and poor adherence with anti-epileptic drugs (AEDs). Other risk factors include use of more than one antiepileptic drug, frequent changes of dose or type of AED, alcohol abuse and certain epilepsy syndromes.
SUDEP is usually unwitnessed but, when witnessed, often follows a convulsion. Many people dying of SUDEP are found in or near their bed. Higher rates of SUDEP are found in studies of people with severe epilepsy, suggesting that people with frequent, severe seizures are most at risk. A recent study found the rate of SUDEP to be identical in men and women.
Gail Bell & Ley Sander]
Institute of Neurology, Queen Square, London, UK
As I prepared this article, I hesitated to include it in this issue because of the fear it would cause among the readers especially those whose friends and dear ones suffer from epilepsy. On the other hand I remembered the many experiences of parents and guardians, I have met, who cannot explain or understand why their client died suddenly. Considering the stigma and false beliefs surrounding epilepsy in the communities, I opted to include this article and I do hope it will further your understanding of epilepsy.
Living with epilepsy causes fear and depression but learning that severe seizures may lead to sudden death causes a lot more fear itself. Dr Robert J Mittan, who has run Epilepsy and Seizure Education for families and patients at the University of Califonia, Los Angeles (UCLA), has written that,
“When these fears are not discussed, they are left unchecked. Fear is the force behind developmentally disabling overprotection and over control of the person with epilepsy. Fear is the force leaving people afraid to be alone and afraid to go out by themselves because of seizures. Fear shrinks life to the house and social contact to the immediate family. Rather than alarming families, discussing causes of death in epilepsy gives them a more realistic appreciation of the risk. The discussion of SUDEP offers a therapeutic opportunity. It is a chance to significantly improve quality of life and reduce harm from seizures.”
Should you require counseling and more information on this and any other issue related to epilepsy, please contact your doctor or ESAU.