Combination Therapy for Epilepsy


Linda Wasmer Andrews

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Epilepsy in the Workplace

Dealing with epilepsy at work can be challenging, but a productive work life is possible.
medication, pills

When it comes to epilepsy treatments, one size doesn’t fit all. In fact, there are more than 20 different antiepileptic drugs (AEDs) available to treat the condition.

Usually, a single medication can help people with epilepsy keep their seizures under control. But if one medication is only partially effective for you, your doctor may sometimes add another drug. Or your doctor may choose to combine your medication with surgery, an implanted device, or a special diet. The ultimate goal is to find the right treatment combination for you—one that optimizes your seizure control and minimizes your side effects.

Epilepsy is a neurological disorder characterized by seizures—but it can affect everyone in different ways. Do you know the facts?

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Nov 6, 2015

2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

Your First AED

Different AEDs may affect you quite differently. When choosing the right one for you, your doctor will consider factors such as the type and frequency of your seizures, your age, and, if you’re a woman, your likelihood of becoming pregnant. The first AED prescribed is often one of these medications:

  • Carbamazepine (Carbatrol, Epitol, Tegretol)

  • Lamotrigine (Lamictal)

  • Oxcarbazepine (Oxtellar, Trileptal)

  • Phenytoin (Dilantin, Epanutin, Phenytek)

  • Valproate (Depacon, Depakene, Depakote, Stavzor)

  • Vimpat (Lacosamide)

Adding Another Medicine

In some cases, you may need to take more than one AED to get the best possible results. Partial seizures, which occur in just one area of the brain, are the most common form of epilepsy. Medications that may be added on to the initial treatment for partial seizures include:

  • Eslicarbazepine (Aptiom)

  • Gabapentin (Neurontin)

  • Lamotrigine (Lamictal)

  • Levetiracetam (Keppra)

  • Oxcarbazepine (Oxtellar, Trileptal)

  • Perampanel (Fycompa)

  • Tiagabine (Gabitril)

  • Topiramate (Topamax)

  • Zonisamide (Zonegran)

Combining medications could reduce your seizures, but it may also magnify side effects, such as tiredness and loss of appetite. Talk with your doctor about any side effects you experience. Some are short-lived or mild. But if your side effects are too bothersome or serious, your doctor may need to adjust your medication dosage or switch to another treatment.
With the right drug therapy, about two-thirds of people with epilepsy are able to live seizure-free. Others may get some relief but continue to have seizures.

Medication + Epilepsy Surgery

If you’ve tried at least two or three medications without success, epilepsy surgery may be an option. Surgery is most likely to help if your seizures arise from a single, well-defined area of the brain that isn’t essential for critical functions like speech or hearing. Removing that area of the brain may stop future seizures or make them easier to manage.

If your seizures continue after surgery but are less frequent or intense, you will need to continue taking medication. However, you may be able to lower your dose or simplify your medication routine.

Even if your symptoms disappear completely, you will need to keep taking medication for at least a couple of years. This helps you avoid developing new seizures while your brain adapts to the results of surgery.

Medication + Implanted Device

There are also surgically implanted devices that help reduce the frequency or severity of seizures for some people. Two options are:

  • Vagus nerve stimulation (VNS). A VNS device is like a pacemaker for the brain. It’s a small, battery-powered gadget that is implanted under the skin of the chest and attached to the vagus nerve in the neck—a nerve that leads to the brain. The stimulator uses this nerve as a pathway to send brief bursts of electrical energy to the brain, which helps prevent seizures. If you have a VNS device, you will usually need to keep taking medication, but you may be able to decrease the dose.

  • Responsive neurostimulation (RNS). An RNS device is implanted in the skull. It has one or two wires that are placed within or on top of the brain at the spot where seizures start. When the device senses abnormal activity in that spot, it sends electrical pulses to help prevent the symptoms of a seizure. Like a VNS device, this stimulator is used along with medication.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Feb 5, 2017

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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