Transcript Treatments
Treatment 1 Anti-epileptic drug treatment Anti-epileptic medications used well are the most effective way of controlling seizures AEDs only suppress and control seizures; they do not treat the cause of the epilepsy They need to be taken regularly as prescribed; failure to do so can result in potentially fatal ‘rebound’ seizures 2 Anti-epileptic drug treatment Know (as far as you can) that the diagnosis of epilepsy is correct. Question the diagnosis tactfully prior to prescribing AEDs Know which medications are reliably available Know which of these medications are affordable 3 The importance of lifestyle How important is it that the person attains seizure control? Do they want/need medication? What about employment issues, driving, pregnancy, stigma/social exclusion How much of a risk is SUDEP for them? 4 AED treatment plan Choose an AED that is right for the seizure type Choose the AED in the light of other medication the person may be taking Ask about lifestyle and life plans before prescribing, being aware of potential side effects 5 Starting treatment Monotherapy is preferable as it keeps side effects and drug interactions to a minimum and keeps dosing simple “Start low, go slow” is the motto. Start on a low dose and slowly increase the dosage until the person attains seizure control or experiences undesired side effects. Some people will attain seizure control on low doses, others can tolerate high doses with good effect and no side effects. Each person and their epilepsy is individual! 6 Side effects What side effects might the person experience on the medication they are going to be taking? And will detrimental (potential) side effects outweigh the benefits of treatment? Warn the person what they may expect in the way of side effects so they know what to report 7 Side effects Some side effects may diminish over 7 – 14 days, once the body has become accustomed to the medication If side effects persist and are detrimental to the persons quality of life, it is appropriate to discuss changing drug treatment Most side effects are dose related and will go once the medication has been reduced or slowly tapered off 8 Serious side effects Some people may experience rare idiosyncratic side effects such as severe rash These are dangerous and the medication needs to be stopped with medical supervision in case sudden withdrawal causes seizures 9 Changing AEDs Changing AEDs needs to be done slowly Particularly with the older medications, there are likely to be adverse effects if the AED reduction is not done very slowly Choose another appropriate first line drug and again “start low and go slow” 10 Adding a second medication This needs to be done only if monotherapy has failed 2 or 3 drugs in combination makes for potentially complicated drug interactions and a greater risk of side effects It can be hard to ascertain which medication is causing adverse effects 11 AEDS for women of, or approaching child bearing age Be aware that some AEDs reduce the effectiveness of the contraceptive pill Some AEDs are associated with a higher risk of foetal malformations if taken during pregnancy (seizure control during pregnancy is important) Taking folic acid supplements can reduce the risk of neural tube defects (spina bifida) 12 Remission How do you know when the epilepsy has gone into remission making treatment no longer necessary? You don’t ! 13 All you can do is: Assess the type of epilepsy: Primary generalised idiopathic epilepsies have a higher rate of remission Seizures caused by head injury are not likely to remiss as the cause is still present Discuss the potential consequences for the person of coming off treatment; how will their life be effected if seizures return? (driving, employment pregnancy, stigma) 14 Check key websites for the latest information National Society for Epilepsy UK www.epilepsynse.org.uk Epilepsy Action UK Drugwatch - Keep up to date with the latest alerts and news relating to epilepsy medication www.epilepsy.org.uk/drugwatch 15 Useful websites The international League Against Epilepsy: www.ilae-epilepsy.org The International Bureau for Epilepsy www.ibe-epilepsy.org 16