1. What are the drug treatments for epilepsy?
1) The timing of treatment should be accurately grasped. Only patients who are diagnosed with epilepsy through specialist examination and evaluation by specialist doctors can start medication, while patients with their first seizure are usually not suitable for medication until the cause and type of seizure are identified.
2) Anti-epileptic drugs should be selected scientifically. Generally, doctors will choose medications based on the type of seizure. Most patients with epilepsy can generally control their seizures with monotherapy if they choose the right medication. At the same time, monotherapy should start with a small dose and gradually increase to the lowest effective drug concentration that can control seizures without significant drug side effects. When monotherapy is not effective, consider switching to another monotherapy, or if multiple monotherapies do not work well, consider a combination of two drugs. It is important to note that the choice of the first two antiepileptic drugs is particularly important. The further you go, whether it is monotherapy or multi-drug combination therapy, the worse the effect will be and eventually it will become refractory epilepsy, so patients with epilepsy should strictly follow medical advice at the beginning of treatment rather than changing medications frequently without authorization.
3) Individualized epilepsy medication is required. The same antiepileptic drug applied to different patients with epilepsy may have different therapeutic effects, so in addition to the general principle of drug selection, individual needs should be fully considered, rather than “one size fits all”. In addition, due to the individual differences of epileptic patients, some patients can have better seizure control at lower concentrations, while some need to increase the dose of medication to control seizures; some have obvious toxic side effects within the therapeutic concentration range, so attention should be paid to timely detection of adverse reactions and timely adjustment of drug type and dose to achieve the best efficacy and minimal side effects.
4) To take anti-epileptic drugs for a long time and regularly. Some patients with epilepsy, the number of seizures is relatively small, so take medication irregularly, “three days to fish, two days to sunbathe”, unauthorized drug reduction, discontinuation of drugs, are treatment a big taboo. In general, patients with epilepsy need to take antiepileptic drugs for a long time, and some patients need to take them for life. If there is a trend of seizure review after drug reduction, the original dose of drug therapy should be restored.
5) For some secondary epilepsy, the cause should be actively searched for and the primary cause should be treated, for example, epilepsy caused by intracerebral tumors requires surgical removal of the tumor and related epileptic lesions to possibly control epilepsy.
2. Is it necessary to start medication as soon as epilepsy is diagnosed, and which epilepsy patients should receive medication?
In general, patients with a clear diagnosis of epilepsy who have at least two seizures within six months should take antiepileptic drugs. If it is only the first seizure, or if there has been more than six months between seizures, antiepileptic drugs are not necessarily needed. In this case, the doctor will usually inform the patient and his or her family about the possible consequences of not taking the medication and the possible side effects of the medication caused by long-term use, and the doctor and patient will decide together whether to use the medication after weighing the pros and cons.
In some cases, such as secondary epilepsy (epilepsy caused by tumors in the brain or after trauma or surgery), it is expected that seizures will be frequent, so even if there are only one or two seizures, antiepileptic drugs should be taken as soon as possible.
3. Under what circumstances should I consider changing my medication for epilepsy?
Switching to an antiepileptic drug should be considered in the following three situations: 1) poor choice of the original drug; 2) intolerable drug side effects with the original drug; 3) the original drug is not effective in controlling seizures. In addition, it should be noted that it is not easy to judge the failure of monotherapy, but should be judged first after the drug blood concentration reaches a certain amount (drug dose ≥ 50% DDD) if the seizures are still poorly controlled before concluding.
4. Under what circumstances should combination drug therapy be considered for epilepsy?
Most patients with epilepsy can control their seizures with monotherapy, but there are still about one-third of patients whose seizures are not well controlled with monotherapy, and these patients have to receive combination drug therapy. It is important to note that monotherapy should be preferred in patients with newly diagnosed epilepsy because polypharmacy may increase the probability of drug side effects and increase the financial burden on the patient. In addition, it should not be easily judged that monotherapy is ineffective. It should be judged that the drug blood concentration reaches a certain amount (drug dose ≥ 50% DDD) if the seizures are still poorly controlled before concluding. If the seizures cannot be effectively controlled after two monotherapy sessions, only then should a combination of medications be considered.
5. Under what circumstances can we consider stopping medication for epilepsy and what should we pay attention to when stopping medication?
Patients who have been treated with antiepileptic drugs for 2-5 years without any seizures can be considered for discontinuation of medication. For patients with surgically treated epilepsy, they should take antiepileptic drugs for at least 2 years after surgery, and then decide to discontinue or reduce the medication based on seizure control and EEG results. The decision to discontinue or reduce medication is based on seizure control and EEG results. About 25%-30% of patients who meet the requirements for discontinuation have a recurrence of seizures during the process of drug reduction or discontinuation. Some types of epilepsy, such as secondary epilepsy due to intracerebral tumors or multifocal epilepsy, have a relatively high recurrence rate; and some epilepsy syndromes, such as LG syndrome, may have a relatively high recurrence rate after stopping medication even if they have not had seizures for 2 years.
In the case of polypharmacy, the withdrawal of the first drug should last at least 3 months before considering the withdrawal of the second drug. Avoid sudden reduction or discontinuation of medication, which can lead to a sudden increase in seizures and even the appearance of life-threatening persistent status epilepticus.
What are the common drug side effects of antiepileptic drugs?
The most common side effects include: drowsiness, dizziness, intellectual impairment, etc. Some drugs may have effects on the liver and blood system, and there may be serious allergic reactions, such as exfoliative dermatitis, etc. Some antiepileptic drugs have certain teratogenic effects.
There are some side effects related to the dose, such as sedation caused by phenobarbital and clonazepam. In order to reduce these side effects, the dose should be slowly increased from a small dose until the therapeutic dose, and the blood concentration of the drug should be monitored regularly during the use.
There are some side effects related to the long-term consumption of drugs, such as valproic acid drugs, long-term application can cause polycystic warm nest syndrome and obesity in women; phenytoin sodium can lead to gingival hyperplasia and hirsutism. Osteoporosis, so for female patients should try to avoid the use of valproic acid-based antiepileptic drugs.
There are also some side effects related to the patient’s own constitution, such as carbamazepine, oxcarbazepine, lamotrigine, etc. may appear exfoliative dermatitis and other serious allergic reactions; valproate drugs may also cause patients to develop liver function damage, so if you need to use the above drugs, you should closely monitor the signs of such adverse reactions.