How do epilepsy medications work

Neurotransmitters cross the synaptic gap between neurons and fix to receptor points of the adjoining neuron. Some neurotransmitters function to excite the joining neuron eg. Other neurotransmitters function to inhibit the joining neuron eg. GABA and inhibit electrical signals passing down that neuron. It is by these electrical and chemical pathways that the millions of neurons within the brain communicate and function normally. Seizures occur when there is an imbalance within these excitatory and inhibitory circuits in the brain, either throughout the brain generalised epilepsy or in a localised part of the brain focal epilepsy , such that neurons "fire off" in an abnormal fashion.

Antiepileptic medications work in different ways to prevent seizures, either by decreasing excitation or enhancing inhibition. Specifically, they act by either:. As the specific mechanisms that cause epilepsy are mostly unknown, drugs with specific mechanisms of action directed at the underlying "epileptic processes" have not yet been developed.

An antiepileptic medication is swallowed by mouth and passes directly to the stomach. Once in the stomach the medication is absorbed into the blood stream where it is then circulated to the brain, via the liver, and acts on the nerve cells.

As the drug is circulating in the blood, it is gradually removed by either the liver breaking it down metabolism or the kidneys filtering it out excretion. Some drug metabolites are active and produce either beneficial antiepileptic effects or adverse side effects. Most commonly prescribed antiepileptic medications are removed from the blood at a rate that allows twice daily dosing to maintain adequate blood levels. Some drugs are removed more quickly than others and have to be taken 3 or 4 times throughout the day, whilst others are removed slowly and can be taken once each day.

For some medications, children need to have blood tests to determine the level in the bloodstream eg. These blood levels are generally measured before a dose is due.

Not all antiepileptic medications need to be monitored with drug levels, as there is not a good correlation between drug level and effect. The dose of medication prescribed is determined by the child's age and weight. Young children and adolescents have greater rates of drug clearance and are often prescribed doses per kilogram of body weight greater than an adult would receive.

In an emergency situation, such as status epilepticus, some antiepileptic drugs can be given directly into the blood stream, into the rectum, nose or buccal to act very quickly to control seizures. The choice of medication and how each is prescribed is a specialist area of paediatrics and child neurology. Prescription of antiepileptic medication is only done by a doctor with knowledge of antiepileptic medication and epilepsy in children.

General principles that doctors follow when prescribing antiepileptic medications in children include:. All medications have the possibility of causing side effects. There are three main types of antiepileptic medication side effects. Please refer to the specific drug information provided with your medication for a more detailed list of side effects. As numerous side effects are listed against all medications, your doctor should help you understand which are the more common or potentially serious side effects to look out for.

It is important to contact your doctor if you are worried about these or other side effects. For urgent information please contact your doctor, pharmacist or the Poisons Information Centre 13 11 26 Nationwide Australia. Always read the consumer information and follow instructions from your doctor and pharmacist carefully.

Any concerns or questions should be discussed with your doctor or pharmacist. It is important to take the exact dose that is prescribed by the doctor at approximately the same time each day. It may take many days or weeks to reach the dose that is most effective. The dose that your doctor is building up to may not be the maximum tolerated or prescribed dose for that medication. Establishing a regular routine can help to avoid medication being missed. Taking medication with meals or using a medication dosette may help.

Maintaining supplies and current prescriptions can avoid running out of medication at the last minute. If a dose is missed it can generally be taken as soon as you remember. These medications are often used for:. Clonazepam Klonopin is a long-acting benzodiazepine. Clonazepam is also a well-known treatment for panic disorder. Clorazepate Gen-Xene, Tranxene-T is also a benzodiazepine. Diazepam Valium, Valtoco, Diastat is used to treat clusters of seizures as well as prolonged seizures.

This medication is also a benzodiazepine. Divalproex Depakote, Depakote ER is used to treat:. Divalproex increases availability of gamma aminobutyric acid GABA.

GABA is an inhibitory neurotransmitter, which means it slows down the nerve circuits. This effect helps control seizures. It can be used as a standalone therapy or an add-on treatment. Serious side effects include anemia and liver failure. In June , the FDA approved this medication for the treatment of seizures. Fenfluramine had previously been used, along with phentermine , in the controversial weight-loss drug Fen-Phen. However, people who take this medication must watch for a rare and serious skin condition called Stevens-Johnson syndrome.

Symptoms can include shedding of your skin. Levetiracetam may cause fewer side effects than other medications used for epilepsy. Methsuximide Celontin is used for absence seizures. It also increases the seizure threshold. It may affect glutamate receptors in your brain. Perampanel can cause life threatening psychiatric or behavioral side effects. Talk with your doctor to learn more.

Primidone Mysoline is used to treat focal seizures and generalized tonic-clonic seizures, including treatment-resistant generalized tonic-clonic seizures. Rufinamide Banzel is used as an add-on treatment for seizures caused by Lennox-Gastaut syndrome. This medication may cause changes in your heart rhythm.

It can also interact with many other medications. Valproic acid is available as a pill and as an oral syrup. All of the brand-name versions have been discontinued. Valproic acid increases the availability of the neurotransmitter GABA.

More GABA helps calm random nerve firings in seizures. Serious side effects are rare, but they may include cognitive problems, weight loss, and kidney stones. Part One of the guidelines focused on the treatment of new onset epilepsy, while Part Two focused on treatment-resistant epilepsy.

Before taking an AED, consult your doctor about the side effects it can cause. Some AEDs may make seizures worse in some people. Use this article as a starting point to ask your doctor for more information. Is CBD Legal? Hemp-derived CBD products with less than 0. Marijuana-derived CBD products are illegal on the federal level, but are legal under some state laws.

If you have epilepsy, you may need daily medications. Learn the prices of these drugs and how to keep costs in check. Brain surgery may be used to treat epilepsy when medications fail to stop seizures. Learn about the benefits and risks. Some people need treatment for life. But you might be able to stop if your seizures disappear over time. You may not need any treatment if you know your seizure triggers and are able to avoid them. AEDs are the most commonly used treatment for epilepsy.

They help control seizures in around 7 out of 10 of people. AEDs work by changing the levels of chemicals in your brain. They do not cure epilepsy, but can stop seizures happening. The best type for you will depend on things like the type of seizures you have, your age and if you're thinking of having a baby.

Some AEDs can harm an unborn baby — see living with epilepsy for more information. If your doctor recommends taking an AED, ask them about the different types available and which is likely to be the most suitable for you.

AEDs are available in a number of different forms, including tablets, capsules, liquids and syrups. You usually need to take the medicine every day. Your specialist will start you on a low dose and gradually increase it until your seizures stop. If the first medicine you try does not work, your doctor may recommend trying another type. It's important you follow any advice about when to take AEDs and how much to take. Never suddenly stop taking an AED — doing so could cause a seizure.

If you have not had a seizure for a few years, ask your doctor if you might be able to stop treatment. If they think it's safe, your dose will be reduced gradually over time.

While taking AEDs, do not take any other medicines, including over-the-counter medicines or complementary medicines, without speaking to your GP or specialist.

Other medicines could affect how well your AED works. Side effects are common when starting treatment with AEDs. Some may appear soon after starting treatment and pass in a few days or weeks, while others may not appear for a few weeks. Contact your GP or specialist if you have symptoms similar to being drunk, such as unsteadiness, poor concentration and being sick. This could mean your dose is too high.

For information about the side effects of your medicine, check the information leaflet that comes with it. In these cases, there's a good chance that your seizures could stop completely after surgery. If your epilepsy is poorly controlled after trying several AEDs, you may be referred to a specialist epilepsy centre to see if surgery might be possible. The results of these tests will help you and your specialist decide if surgery is an option for you, and what the result of surgery might be.