Table of Contents
Reasons for Failure. An AED may fail to reduce seizures due to such factors as:
- The wrong dose level.
- Improper timing.
- Introducing the medication too rapidly.
- Not managing conditions that triggered the seizure.
- Instability of the drugs. Many of the tablet forms disintegrate easily with moisture, so pills should be stored in a dry place, not in the bathroom, and kept away from heat.
- Patients not taking medication as prescribed. Some patients experience difficult side effects from older AEDs, which often cause them to stop medications. Among the most distressing are sleepiness, problems in coordination, and weight gain.
- Some patients who do not respond to AEDs may actually have nonepileptic seizures.
The doctor should first address these issues. If the patient still does not respond, the doctor will usually try a different drug. If this fails, one or even two additional drugs may be used. When seizures do not respond to the first two or three drugs, the odds of a fourth or fifth working diminish greatly. In such cases, the patient should ask about surgical alternatives.
Healthy Behaviors. Unhealthy behaviors, such as smoking and alcohol use, can interfere with medication effectiveness.
Monitoring Effects
During the first few months of therapy, the doctor will probably order blood tests once or twice to monitor drug levels and, if necessary, adjust dosages. Monitoring is used to check for AED complications, and to be sure the patient is complying with the regimen. These blood tests may be, however, a less reliable indicator of problems than patients’ own self-observations of response to the drug. For instance, blood tests may suggest that the dosage levels are insufficient according to general standards, yet the individual patient may be seizure-free and leading a normal life. It is very important that women have AED levels monitored during pregnancy (see "Treatment During Pregnancy" below).
Discontinuing Drug Therapy
Patients who can generally withdraw from medications and remain seizure free within a five-year period include those who:
- Respond well to anti-epileptic drugs , as indicated by good control of seizures within the first year
- Do not have risk factors for more severe epilepsy
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Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
