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Medications

At Cleveland Clinic, we individualize epilepsy treatment plans based on the type of seizure patients are experiencing.

We treat each patient's case in a personalized, individual way. We create a treatment plan based on the type of seizure a patient is experiencing. Our goal is to achieve the best possible seizure control without adverse side effects from the medication.

In most patients with epilepsy — between 60 and 70 percent — anti-epileptic or anticonvulsant medications control seizures. For most children, it is possible to stop the seizures altogether with standard medications.

FDA-approved Epilepsy Medications

Today, there are more than 20 FDA-approved medications for epilepsy, including:

  • Benzodiazepines
    • Diazepam (Diastat, Diazepam Intensol, Valium)
    • Lorazepam (Ativan, Lorzepam Intensol)
    • Clorazepate (Tranxene)
    • Clonazepam (Klonopin)
  • Carbamazepine (Tegretol/Tegretol XR/Carbatrol)
  • Felbamate (Felbatol)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Levetiracetam (Keppra)
  • Oxcarbazepine (Trileptal)
  • Phenobarbital
  • Phenytoin (Dilantin, Phenytek)
  • Primidone (Mysoline)
  • Tiagabine (Gabitril)
  • Topiramate (Topamax)
  • Valproic acid (Depakene, Depakote)
  • Zonisamide (Zonegran)

These medications act to dampen, or diminish, abnormal or excessive electrical activity in the brain which is associated with seizures and epilepsy.

Treating Children

For most children struggling with epilepsy it is possible to stop the seizures altogether with standard medications. Children who do not respond to traditional antiepileptic drugs may be entered into clinical trials of approved or investigational medications. Cleveland Clinic’s active role in national clinical trials ensures that our patients receive the latest medication and treatment for pediatric epilepsy.

Frequently Asked Questions About Epilepsy Medications

Below, learn more about epilepsy medications by reading answers to common questions:

How do I choose which drug to take?

There are many types of epilepsy and many anti-epileptic drugs. Each person responds differently to a given drug. The choice is influenced by factors specific to the patient, such as side effect profile, seizure types, frequency and severity of seizures, age, sex, overall health and medical history. You and your doctor can discuss which drugs will best treat your epilepsy. You may have to try more than one drug before you find the one that works best for you.

Should I take more than one medication?

Monotherapy is treatment with a single drug and is preferred if possible. Unfortunately, sometimes no single drug is effective, so you and your doctor may consider a combination. Many newer medications approved by the Food and Drug Administration are licensed as “add on” treatments to help boost the effectiveness of older medications. However, combinations of more than two drugs increase the risk of complications and should be used with caution.

How often and when do I take my medications?

All the approved medications for epilepsy are taken orally — as tablets, coated pills, capsules, syrups or liquids. They differ according to how often they have to be taken. If your schedule makes it difficult to take a medication several times a day you may want to consider one that can be taken once a day. Flexibility may be important to you. Some drugs stay in the bloodstream longer than others; if you are taking one of these, it is less important to take it at a precise hour. If you have seizures at night, you may be able to take extra doses of your medication before bedtime.

The more regularly and consistently you take your medication(s), the better chance you have of controlling your seizures. It is human to forget a dose or take it late, so don’t panic if it happens. If you forget a dose and realize your mistake within 24 hours, take the dose immediately, then delay the next scheduled dose by four hours. Let’s say you are supposed to take an anti-epileptic pill twice a day. You realize at 6 p.m. you forgot to take your morning dose. What should you do? Take the missed dose immediately and wait until at least 10 p.m. to take the second dose.

Always take medicine at the same time each day, best fitted to your daily routine. A weekly pillbox is necessary in order to see if a dose has been missed. Other strategies include using alarms on watches, cell phones or clocks. Of course, family members and friends can help with reminders as well.

In most patients with epilepsy — between 60 and 70 percent — anti-epileptic or anticonvulsant medications control seizures. Today, there are more than 20 approved medications for epilepsy. The seizures associated with epilepsy result from abnormal or excessive electrical activity in the brain. These medications act to dampen or diminish that activity.

What kinds of side effects should I expect?

Typical side effects include fatigue, sleepiness, mental fogginess or unsteadiness. These tend to occur an hour or two after a dose of medication, especially if the medicine is taken on an empty stomach.

Other, rarer side effects are unique to specific medications. For instance, Dilantin may cause your gums to swell, while Depakote can cause hair loss, weight gain or tremors. Keppra sometimes causes mood swings and Topamax can cause a tingling sensation or kidney stones. These side effects typically develop over time with long-term treatment.

Finally, there are some very rare, unpredictable side effects that can be quite serious. These include skin rashes, low blood cell counts and liver problems.

Of course, you may not experience any side effects or they may be minor. The severity of the side effects will likely depend on the type of medication, dose and length of treatment. Side effects are worse at higher doses, but they become less severe over time as your body adjusts to the medication. A simple, effective way to avoid or reduce side effects is to always take your medication with food. This helps the body adjust by slowing absorbing the medication into the bloodstream.

How long will I have to take medication?

The answer depends on the type of epilepsy you have and your response to medication. Some patients need treatment for a few years, while others require medication their entire lives. Some patients who are treated for a single, first seizure and who do not have other risk factors for epilepsy may go off treatment as soon as one year.

With some exceptions, patients who are seizure-free for some years should be re-evaluated to determine whether the drug can be discontinued. How long the seizure-free period should be varies among the types of epilepsy. The decision to discontinue a medication depends on additional factors, including whether the patient has normal neurological function, prior MRI evidence of brain problems and EEG findings. If a medication is going to be stopped, it should be weaned — gradually lowered in dose — to avoid triggering a seizure.

Learn more about epilepsy medications:

For Patients Who Don't Respond to Medications

Some people have seizures that do not respond to medication(s), or they experience intolerable side effects. When epilepsy does not respond fully to medication(s), it is called medically intractable, or pharmacoresistant epilepsy. If you are among these people, talk to your doctor. Surgery or alternative therapies may help.

Learn more about pharmacoresistant epilepsy:

For Medical Professionals:

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To make an appointment call us locally at 216.445.0601 or toll-free at 866.588.2264.

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Interested in epilepsy services in Florida?

Cleveland Clinic Florida’s adult epilepsy program is offered at the Weston campus, located just south of Fort Lauderdale.