Hesperian Health Guides
Starting medicine for epilepsy
HealthWiki > Epilepsy and Seizures > Chapter 4: Medicines for epilepsy and seizures > Starting medicine for epilepsy
Health workers who regularly treat seizures and epilepsy will ask many questions to identify the seizure type and what is causing seizures. This helps them determine the best treatment and medicine for a person’s seizures. For information about questions that health workers may ask about epilepsy and seizures, see Chapter 3.
A seizure can be caused by a health condition other than epilepsy, such as meningitis, malaria in the brain, or others. High fever in very young children can also cause seizures. The medicines used to treat these conditions are different than the medicines for epilepsy and are not all discussed in this chapter.
Tell the health worker if you are:
- taking any other medicines. Medicines that are safe and effective can sometimes not work well or cause harm when taken with another medicine, for instance, some birth control pills.
- pregnant or breastfeeding. Antiseizure medicines can pass to the baby during pregnancy or through breast milk. For information about the safety of medicines during pregnancy and breastfeeding, see Chapter 7.
Once you and your healthcare team decide on a medicine, you will start using a standard dose. Typically, a dose starts low and is slowly increased until seizures are controlled.
If the medicine does not stop your seizures or if it causes discomfort or other problems, the doctor may adjust the dose or give you a different medicine to try. Finding the best medicine and the best dose can take time. If the medicine you start taking does not work at all or does not work well enough, you may have a different type of seizure disorder and need a different antiseizure medicine.
For example, juvenile myoclonic seizures look a lot like generalized tonic-clonic seizures. But instead of treating them with carbamazepine, they respond to valproic acid or lamotrigine.
Contents
Finding the right dose: Dosing by body weight
The first doses of antiseizure medicine are calculated based on a person’s body weight, especially for children and others with smaller bodies. The starting dose is typically at the lower end of a medicine’s dosing range. The goal is to try to find a dose that will stop the person’s seizures.
The instruction “Give 5 mg per kg of body weight by mouth 1 time a day” means:
- for every kilogram a person weighs, they should take 5 mg of the medicine, and
- they should take this dose once every 24 hours.
Example: A 10-year-old girl is given carbamazepine for her seizures. She weighs 32 kilograms (kg). The starting dose for children 1 to 11 years old is 5 mg per kg of body weight.
Calculation: Multiply recommended dose by weight: 5 mg X 32 = 160 mg
What tablet sizes are available: Carbamazepine tablets are usually available in 100 mg or 200 mg. Tablets can be cut to get a close-to-accurate dosage. The closest possible dose for this child will be:
- either 1 whole plus ½ of 100 mg carbamazepine tablets each day (150 mg total), or
- ¾ of a 200 mg tablet each day (150 mg total). See information about splitting doses. See information about measuring medicine in tablet and liquid form.
Finding the right dose: Dosing in a range
Antiseizure medicines are often recommended in dose ranges. This allows medicine amounts to be adjusted to meet individual needs because different people’s bodies absorb and process medicines differently.
When dosing within a range, you usually start with a low dose and increase it slowly over 6 to 12 weeks until you reach the right dose. The right dose is one that will stop the seizures and cause the fewest side effects. If seizures stop with the first amount, you might then lower the dose to see if that stops seizures as well. Each medicine has a maximum dose. Increasing the dose above that amount is not safe and will not stop the seizures.
Having more severe seizures does not always mean that you need a larger dose.
Example: The dose of carbamazepine for children 12 years and older is: 100 to 200 mg by mouth 1 time a day, or 50 to 100 mg by mouth 2 times a day, with a maximum dose of 1800 mg per day. That range means you might start with a dose of 100 mg of carbamazepine and then add more each week until the seizures stop or the maximum dose of 1800 mg is reached.
Splitting daily doses into smaller doses
It is common to split a daily dose of antiseizure medicine into 2 or 3 smaller doses to be taken at different times during the day. Splitting a dose can be helpful because it keeps the amount of medicine in a person's body more constant at all times. Side effects of a medicine may be less intense with smaller doses than with a single large dose. Check with a health worker who has experience with antiseizure medicines to find out if splitting a dose might be helpful for you.
If splitting involves cutting a larger tablet into smaller pieces, ask the clinic or pharmacy to cut them for you. Pharmacy workers (or chemists) have tools that cut pills accurately, making sure each part has the right amount of medicine (see “Measuring medicines”).
Of course, splitting doses also gives a person more chances to forget or miss a dose. Take this into account as well and help the person find ways to remember to take their medicine.
Add-on therapy
Sometimes a new medicine is added to supplement an antiseizure medicine that is not completely controlling seizures. This is called “add-on therapy.” Follow add-on therapy instructions carefully.
There are several reasons for using an add-on therapy. When one antiseizure medicine is not completely controlling a person’s seizures, a different antiseizure medicine that affects the brain differently might be added to see if by working together both medicines can stop the seizures. In combination, the effects of each medicine are sometimes increased. Also, add-on therapy may allow smaller doses of each medicine to be used, reducing side effects.
Adding on lamotrigine to valproic acid can result in a lower dose of valproic acid. Levetiracetam is added on to other antiseizure medicines to better control several seizure types. For more add-on therapy information, see the specific medicine boxes in “Common antiseizure medicines”.
Follow-up visits
The health worker who started you on medicine will want to see you several times after you start. During follow-up visits, they will ask about how well the medicine is controlling your seizures, or about side effects or allergic reactions, and they may adjust your dose or change the medicine so it works best for you.
Try not to miss follow-up visits. If it is difficult for you to go, maybe the health worker can come to you where you live, or connect over a phone or video call. If there is a health center that is closer for you, ask your health worker for a referral note with their name, phone number, and any important instructions for a different health center. Ask about mobile health clinics or epilepsy camps that provide epilepsy screening, access to antiseizure medicines, and tips to live well with epilepsy.
