Medication for epilepsy

Also called anti-epileptic drugs, AEDs or anticonvulsants

Anti-epileptic drugs (AEDs) are the main form of treatment for people with epilepsy.

AEDs work by stabilising the electrical activity of your brain. Up to 70% (7 in 10) people with epilepsy could have their seizures completely controlled with AEDs. Read more about epilepsy.

Which anti-epileptic drugs are available in New Zealand?

There are several different AEDs available in New Zealand. The commonly prescribed AEDs include:

Others include:

  • acetazolamide
  • clonazepam
  • ethosuximide 
  • gabapentin 
  • lacosamide
  • oxcarbazepine 
  • phenobarbital
  • pregabalin
  • primidone
  • retigabine
  • rufinamide
  • vigabatrin
  • diazepam
  • midazolam

Different AEDs for different seizure types

Some AEDs are more suitable for different seizure types than others. Read more about the different types of seizures. The following is a guide:

Generalized seizures

Type of seizure AED options
Absence seizures acetazolamide, clonazepam, ethosuximide, lamotrigine, sodium valproate
Myoclonic seizures clonazepam, sodium valproate, topiramate
Atonic seizures sodium valproate, lamotrigine, topiramate
Tonic seizures sodium valproate, lamotrigine, topiramate
Tonic-clonic seizures acetazolamide, carbamazepine, clobazam, lamotrigine, phenobarbital, phenytoin, primidone, sodium valproate, topiramate

Focal seizures

Type of seizure AED options
Simple focal seizures acetazolamide, carbamazepine, clobazam, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, primidone, retigabine, sodium valproate, topiramate, vigabatrin
Complex focal seizures gabapentin, lacosamide, levetiracetam, phenobarbital, phenytoin, pregabalin, retigabine, topiramate, vigabatrin, carbamazepine

What about the side effects?

All AEDs have side effects although not everyone gets them. Some side effects may impact your lifestyle more than others. Some side effects may be life threatening. Talk to your health care provider about possible side effects with your medication. 

  • Common side effects when starting AEDs include tiredness, feeling sleepy, dizziness, dry mouth, feeling sick (nausea), diarrhoea (loose stools) and stomach upset. These usually go away as your body gets used to the medication. 
  • Life threatening side effects that are possible with some AEDs include severe skin reactions, problems with your liver and problems with your blood cells such as your white blood cells or platelets.
  • To help reduce your chance of side effects, your doctor may:
    • start you on a lower dose, then gradually increasing it; this allows your body to slowly get used to the medicine
    • ask you to have blood tests to make sure you are taking the right dose and check you don't have serious side effects. 

Starting anti-epileptic medication

The decision when to start medication can be difficult. A first seizure may not mean that you will have a second seizure and a second seizure may not occur for years later. The decision to start medication should be made by thinking about the benefits and risks of starting, or not starting, the medicine. It is unusual to start treatment after a first seizure. A common option is to wait and see after a first seizure. If you have a second seizure within a few months, more are likely, so it may be a good idea to think about starting medication.

Choosing anti-epileptic medication

Deciding on which anti-epilepsy medicine is best for you depends on many things such as:

  • your type of epilepsy
  • your age
  • the possible side-effects of the AEDs and how they might impact your lifestyle  
  • other medicines that you may take for other conditions, and possible drug interactions
  • whether you are pregnant – read more about epilepsy and pregnancy
  • whether you are planning a pregnancy – read more about epilepsy and contraception.

Your health professional can discuss the best medication for you. It may take some time to find the AED that works best for you. In most cases, only one AED is needed to prevent seizures, but some people may need two or more medicines.

Assessing the benefits and risks

It is also important for you to think about the benefits and risks of taking, or not taking, AEDs. This may depend on how your seizures affect you and how often they happen. The following table sets out what you might want to think about to help you decide whether to take AEDs or not.

Benefits of taking AEDs Risks of taking AEDs

  • Reducing or stopping your seizures so that they don’t interfere with your day-to-day life. Up to 70% (7 in 10) people with epilepsy could have their seizures completely controlled with AEDs.
  • Reducing the chance of your seizures causing you to have accidents or injuries.
  • Reducing your worry that you will have a seizure.
  • Reducing the chance of getting status epilepticus which are seizures that continue without stopping, or a series of seizures that happen for 30 minutes without you recovering in between. This can happen with any seizure type.
  • Having side effects from the medicine.
  • Needing to remember to take your medicine regularly. 

Getting the most from your medication

AEDs are usually available in tablets, capsules and liquids. If you find taking tablets difficult, ask your doctor to prescribe you something easier to swallow — some tablets are chewable or crushable.    

Epilepsy medicine is usually taken once or twice each day. Sometimes it is taken 3 times a day. It’s important to take it regularly, as prescribed by your doctor, because missing a dose can increase the risk of having a seizure. Read more about tips for remembering to take medicine.

Once you are prescribed epilepsy medicine, it’s a good idea to get advice about what to do if you ever forget to take it. The advice your doctor or pharmacist gives you will depend on which epilepsy medicine you are taking, and the dose.

How long do I have to take AEDs?

AEDs do not cure epilepsy, but they can stop the seizures happening. For some people, having epilepsy is a lifelong condition and they will need to continue taking medication. If you have not had a seizure for 2 or more years, you may want to discuss with your doctor about the option of coming off treatment. This will depend on several things, including the possible impact of seizures returning.  

When coming off AEDs, it is important that it is done slowly. Suddenly stopping treatment can cause seizures to start again or happen more often and last longer than before. You can plan with your doctor how to come off the medication slowly and decide what to do if your seizures start again. If seizures do start again, taking the same AED straightaway usually gives you the same control over your seizures as before. However, sometimes the AED may not work as well as before.     

Learn more

The following links provide further information about anti-epileptic medication. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Epilepsy Better Health Channel, Australia, 2013 
New to epilepsy treatment Epilepsy Society, UK 
About epilepsy: the basics Epilsepy Foundation, US

References

  1. Prescribing issues associated with anticonvulsant medications for epilepsy BPAC, November 2009 
  2. Antiepileptic drugs New Zealand Formularly
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 23 Jul 2017