Some medications are taken as a ‘course of treatment’ to cure a condition (for example, taking a course of antibiotics for an infection). Anti-seizure medication (ASM) is different; it is a preventative medication taken every day to try and stop seizures from happening. It does this by reducing the excessive electrical activity in the brain that causes seizures. The way ASM works is not completely understood, and it is likely that different ASMs work in slightly different ways.
What is the aim of treatment with ASM?
The aim of treatment is ‘optimal therapy’. This means taking the fewest types of ASMs, at the lowest dose in order to get the best seizure control possible with the fewest side effects. If optimal therapy cannot be found with one particular ASM there are usually several others that can be tried, alone or in combination.
How is ASM chosen?
There are about 30 ASMs and each has a particular type or types of seizures that it works for. The choice of ASM firstly depends on the type of seizures you have, and which ASM works for these seizures. NICE has recommendations about which ASM should be used for different types of epilepsy and seizures.
When a drug is chosen, your specialist will take into account any other conditions you have or medication you take. As you may be on drugs for a number of years, they will consider not just what is right for you right now but also for the future. For example, when a girl is first prescribed ASM they will think about when she becomes an adult and may want to start a family.
Some ASM can affect an unborn baby while it is developing and so these drugs are usually avoided for girls and women who may become pregnant.
Although ASM recommendations are largely the same for men, women and children, there are some reasons why a particular ASM might be chosen or avoided for a particular person. This may be due to possible side effects. For example, some ASM can affect concentration more than others so they might be avoided for a student at school or college.
You are entitled to free prescriptions for your ASM and any other prescribed medication. To apply for free prescriptions in England you need to fill in a FP92A form (from your GP surgery or pharmacy). In Scotland, Wales and Northern Ireland all prescriptions are free for everyone.
Treatment is usually started with a first line ASM. This is an ASM that is tried first and taken on its own, sometimes called monotherapy. Once the most appropriate ASM for you has been identified and discussed with you, you will usually start on a very low dose. This helps your body get used to the medication, and makes side effects less likely. The dose is then increased slowly over a number of weeks until it stops your seizures. The right dose for you may be different to what is right for someone else and is sometimes referred to as your ‘individual therapeutic concentration’.
How the body absorbs, uses and removes medication changes with age. For children, ASM doses are based on their body weight and so the dose increases as they get older (up to around 12 years of age). For adults, doses are not based on body weight.
For most people, once the right ASM for them is found, it will stop their seizures. Although for some people it can take time to get this right, the aim is to stop your seizures by just taking one ASM. However, if your seizures do not stop when the dose is increased, or you start to have side effects, you may want to talk to your doctor about changing to a different ASM. Because different ASMs work in different ways, if one does not control your seizures it doesn't mean that other ASMs won't work. If you change from one ASM to another, the second ASM is usually added and slowly increased to a dose which is likely to work, and the original drug is slowly reduced.
If your seizures are not controlled with a single ASM you may take a combination of ASMs. This is called polytherapy. Some ASMs added to a first line ASM are called second line ASMs. This is slightly different for children because ASMs are not split into first and second line for treating children age 12 and under.
Some people continue to have seizures despite taking ASM. In this case they may continue to take ASM to reduce their seizures as much as possible and consider trying other types of treatment.
What if medication doesn’t work for me?
Most people's seizures are controlled with medication. That is why medication is usually the type of treatment that is tried first. But if medication doesn't stop all your seizures, or only stops some of them, there are other types of treatment that might be considered. This might be instead of, or alongside ASM. Rather than waiting until you have tried lots of different ASMs, your specialist might talk to you about alternatives if two or three ASMs have not worked for you.
For example, someone may be considered for epilepsy surgery, VNS (vagus nerve stimulation) therapy, specialist medical dietary treatments (such as the ketogenic diet which is particularly for children) or deep brain stimulation.
Some people consider using complementary therapies alongside ASM. Most complementary therapies are not used to treat epilepsy but some people find them useful to manage stress, or feel more in control of their life.
If your seizures are not controlled with medication, your specialist may want to review your diagnosis to check that it is correct, to confirm the type of epilepsy or seizures you have, and to review the treatment you have had so far. They may refer you to a tertiary service (a specialist hospital or unit the focuses on specific care for different conditions) if they feel that more specialist treatment would be appropriate for you.
Who will be involved with my epilepsy care?
If you or your child have been diagnosed with epilepsy, it is likely that you will have seen a neurologist, or a paediatrician or paediatric neurologist. You may already have discussed treatment options with them. They will usually prescribe your ASM and arrange follow-up appointments to see how you are getting on.
Where we refer to a ‘specialist’ this means a neurologist for adults and a paediatrician for children. Once a child reaches around 16 to 18 years of age they will usually change from seeing a paediatrician to a neurologist. This is called ‘transition’.
The day-to-day management of your epilepsy might be under the care of your GP. For example, they might organise your prescriptions. They should also have a copy of your treatment plan so you can talk to them about how you get on.
You might also see an epilepsy specialist nurse (ESN). ESNs work alongside the specialist and GP to help you manage your epilepsy. Not all hospitals have an ESN but you can ask about this at your local hospital.
In the longer term, if your seizures become controlled, you might only see your GP to review your epilepsy each year.
How to ensure you are prescribed the same drug:
- Ask your doctor to prescribe by brand name so the pharmacist has to give you that version.
- If your doctor writes the generic name of the ASM on your prescription, ask them to add the name of the specific drug company.
- Try to go to the same pharmacist each time as they may have a record of your ASM and may ensure that you receive the same version.
- Check your ASM while you are still at the pharmacy. If they are different to the ones you usually take, discuss this with your pharmacist. If you have a smartphone you could use our free smartphone app to photograph your ASM and show them to your pharmacist.
For most people with epilepsy, the treatment for their seizures includes anti-seizure medication (ASM), previously known as anti-epileptic drugs or AEDs. But what do these drugs do?
List of anti-seizure medication (ASM), previously known as anti-epileptic drugs or AEDs, with details including dosage and possible side-effects.
Our 'a closer look' series of information looks at some subjects in greater technical detail. Here we try to answer some of the more common questions about anti-epileptic drugs (AEDs).
Getting the same version of anti-epileptic drugs (AEDs) with each prescription may contribute to how well the drug works for that person.
As with all medications AEDs can cause side effects and possible side effects vary from one AED to another.