Seizure Treatment

The primary treatment for seizures is antiepileptic medicine. Seizure medications do not cure seizures, they control seizures. Unlike antibiotics, you cannot take seizure medicines for 10 days and be cured.

Your child needs to take the medicine on a regular basis every day to keep an even level of medication in their body. Most medications are taken two (2) times each day but some may be taken only once a day and some may need to be taken three (3) or four (4) times a day. The type of medicine used for your child will depend on the type of seizures, your child’s age and health, and possible side effects of the medications. For example, one medicine can cause an increase in hunger and weight gain so if possible we avoid using this medication in children who are already overweight.

There are many medications available to help children with epilepsy. Medications used most often include:

• Levetiracetam (Keppra®)
• Valproic acid (Depakene®, Depakote®)
• Topiramate (Topamax®)
• Lamotrigine (Lamictal®)
• Oxcarbazepine (Trileptal®)

The amount of medication prescribed is based first on your child’s weight but then may be adjusted up or down based upon seizure control and/or side effects. Our goal is to prevent all seizures without causing any intolerable side effects.

All medications (even over the counter medicines such as acetaminophen) have the risk of side effects. All seizures medications have some risk of side effects. Most side effects are not serious but occasionally they can be more severe.

The most common side effect of seizure medications is feeling sleepy. When first starting a medication or when the dose is increased some children may feel a little drowsy for the first few days. Most children adjust to the medication and are back to feeling normal within a week. We often start with a very low dose of medicine and slowly increase the dose to help control the sleepy feeling. Sometimes we have to increase the dose more quickly if a child is having frequent seizures and sleepiness may be more of a problem for the child.

Other side effects may include dizziness, upset stomach, and skin rash. A few medications can affect appetite. All seizure medications carry some risk of change in mood and behavior, including a very small risk of thoughts of suicide. Your doctor or nurse practitioner will always discuss side effects of your child’s medication with you.

Most children can use the generic form of seizure medications. Sometimes a child will be sensitive to even slight changes in their medication. These children may need to use the brand name medication. When starting a medication it is usually okay to start with the generic. If problems arise the healthcare team can change the prescription to the brand name.

Your child’s response to seizure medications may change when other medications are started. This could increase your child’s risk of having seizures or increase the risk of side effects from the medications.

If your child has a runny nose, cough or other cold symptoms, avoid use of over the counter medications if possible. Acetaminophen and ibuprofen are generally safe to use for treating pain and fever. Medications containing pseudoephedrine should be avoided as they may increase the risk of seizures but if necessary they can be used sparingly.

Some birth control medications may interact with seizure medications and cause either the birth control or the seizure medicine to be less effective. Talk with your doctor or nurse practitioner before starting any form of birth control.

To minimize the risk of drug interactions, keep a list of all medications your child is taking, including the dose, to share with your doctor or nurse practitioner at each appointment. It is important to talk to your doctor, nurse practitioner or pharmacist before giving your child any other medications. This includes prescription medications, over-the-counter medications, vitamins and herbal supplements.

If your child vomits within 15 minutes of taking his medicine, you can repeat the dose one time.

If he vomits again, do not give him any more medication. Wait until the next scheduled dose and try again.

If he vomits and it has been at least 15 minutes since he took his medicine, do not give any more medication. The medicine has already been absorbed into his body.

It is important to take all seizure medications on a regular basis as prescribed by your child’s doctor or nurse practitioner.

• Missing one or more doses of medication will increase the risk of a seizure.
• If you forget to give a dose of medicine, give it as soon as you remember and give the next dose later if possible.
• Do not give two (2) doses of medication closer than about six (6) hours apart.
• Missing one (1) dose of medication or giving it late every once in awhile will not cause a seizure in most children, but some children may be more sensitive to this.
• Missing several doses is likely to cause a seizure.

When we first start a medication your child receives the lowest dose we think will work. This may not be the right dose and we may need to increase the dose several times to get to the right level of medication for your child. We can often increase a dose of medication three or four (3 or 4) times the starting dose before it is too much medicine for your child. If we reach the maximum dose for the medication and your child is still having seizures we may need to try a different medication or add another medication. Unfortunately, there is no magic bullet for seizures. The first seizure medication chosen has about 60% chance of controlling seizures. If that medication fails, the chance of seizure control drops to 10%. If two medications fail, then there’s only a 1-2% chance of controlling seizures. Therefore, if two (2) medications have not worked for your child we may consider other treatments. These therapies are described briefly below. Your neurology provider can give you more information if these therapies are appropriate for your child:

•  Diet Therapies – The Ketogenic Diet and Modified Atkins Diet are very restrictive low carbohydrate diets that may be used to treat epilepsy. These diets must be started and monitored closely by a team of specialists, including a dietitian.
•  Vagal Nerve Stimulator – This treatment involves placing a device that looks like a pacemaker in the chest. The device has a wire attached that leads to the vagus nerve in the neck. The device regularly stimulates the vagus nerve which then stimulates the brain resulting in a decrease in seizures. This treatment usually does not result in complete control of seizures and is not a substitute for medication. It requires surgery so it is not offered as a first line treatment for seizures. It is not brain surgery. It is usually added to medications when they are not working to completely control seizures but does not replace medication.
• Epilepsy Surgery – If a child has partial seizures which come from one area of the brain, surgery can sometimes be performed to remove the affected area. This type of surgery may “cure” epilepsy and the child may be able to stop all of their seizure medication over time. This is not an option for all children with epilepsy. An extensive evaluation is done before offering this treatment. This option is not usually considered unless a child’s seizures are not controlled by the first or second medication tried.