Epilepsy is a common neurological condition affecting approximately 50 million people worldwide. In Malaysia, about eight in every 1,000 individuals are diagnosed with epilepsy. The condition often develops following structural brain damage caused by serious head injuries, tumours, or strokes. Interestingly, around 30% of cases have a family history of epilepsy, suggesting a genetic link, although the exact cause remains unclear. Other potential seizure triggers include brain infections, low blood sugar levels, and excessive alcohol consumption.
People with epilepsy often experience recurrent seizures, which are short episodes of involuntary movements affecting either a specific body part or the entire body. These movements happen due to sudden, abnormal brain activity. In addition to involuntary movements, seizures can also cause temporary loss of awareness, fainting, muscle stiffness, and loss of bladder or bowel control.
The role of antiepileptic medicines in seizure prevention
Antiepileptic medicine is the cornerstone of epilepsy treatment. Although seizures cannot always be cured, they can often be effectively managed with antiepileptic medicine. Patients can achieve seizure control with the right treatment plan, significantly improving their quality of life.
Treatment is only initiated once epilepsy is diagnosed, and the choice of medicine depends on various factors, including the type and severity of seizures, age, gender, and social considerations. Epilepsy treatment is not a one-size-fits-all approach; each patient’s care plan is tailored to their unique needs.
Most antiepileptic medicines work by either suppressing the overactive brain signals or enhancing the brain’s natural ability to maintain stability. These medicines can be categorized into two types:
- Broad-spectrum; which is effective for a wider variety of seizures. Some examples of broad-spectrum antiepileptic medicines include valproic acid, lamotrigine, levetiracetam, topiramate, and clonazepam.
- Narrow-spectrum; which targets specific types of seizures more effectively. Narrow-spectrum antiepileptic medicines consist of phenytoin, phenobarbital, carbamazepine, gabapentin, and pregabalin.
Epilepsy treatment needs to be tailored to each patient’s condition. Some individuals may only require one type of medicine, while others might need a combination to achieve good seizure control. The goal is to identify the most effective medicine for seizure control while fine-tuning the dosage to minimize side effects.
If the prescribed medicine causes side effects or is ineffective, the doctor may adjust or switch the treatment to ensure a balance between seizure control and the patient’s well-being. Changes in medicines may also be necessary if a patient experiences significant side effects that impact their quality of life.
Like any other medicines, antiepileptic medicines can have side effects, which is one of the reasons some patients stop taking them. Common side effects include headaches, dizziness, drowsiness, confusion, loss of balance or coordination, and tremors. Additionally, some patients may experience stomach discomfort, nausea, or vomiting. Some antiepileptic medicines may also cause a rash. Particular attention should be given if the rash becomes painful, starts peeling, or feels like burning. These side effects are often related to the prescribed dose and may improve over time or with dose adjustments by a doctor.
Advice to patients and the general public
Epilepsy patients should never stop or skip their antiepileptic medicines without consulting a healthcare professional. Adherence to medicines intake is the key to effectively control seizures. Uncontrolled seizures can lead to serious complications such as emergency hospital visits, injuries from falls, and even life-threatening situations.
If seizures become uncontrolled or side effects occur, patients should immediately inform a doctor or pharmacist. Therapeutic drug monitoring (TDM) is a blood test that can be performed to ensure medicine levels are appropriate (not too low, which could trigger seizures, and not too high, which may cause side effects). Pharmacists may provide recommendations based on these results, and doctors will review and adjust the treatment plan accordingly.
Some patients may achieve seizure-free status after taking antiepileptic medicines for a certain period. However, this condition does not necessarily mean that they are completely free from epilepsy. Seizures may still recur, and the condition requires ongoing monitoring. Therefore, any decision to discontinue treatment should be made cautiously in consultation with a doctor, weighing the benefits and potential risks before making any changes.
Every dose matters, a step towards seizure control
Epilepsy patients should adhere to their prescribed antiepileptic medicines to ensure both their safety and the well-being of those around them. Side effects or disruptions to daily activities should not be a reason to stop the treatment. Instead, patients are encouraged to consult their doctors or pharmacists to explore possible adjustments and find a treatment plan that best suits their needs. With proper management and support, epilepsy can be effectively controlled, allowing patients to lead a better quality of life.
If there are any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8 a.m. to 5 p.m., except on public holidays.
This article was prepared by Mary Anne Ng Wee Lyn (Pharmacist) from Bahagian Perkhidmatan Farmasi, Jabatan Kesihatan Negeri Pulau Pinang for Bahagian Amalan dan Perkembangan Farmasi (BAPF), KKM x The Malaysian Medical Gazette Series. It is hoped that this collaboration will help propogate information regarding medication to the general public.
REFERENCES
- Al-Aqeel S, Gershuni O, Al-Sabhan J, Hiligsmann M. Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Cochrane Database of Systematic Reviews 2020 -10-22;2020(10).
- World Health Organization. Epilepsy. 2024; Available at: https://www.who.int/news-room/fact-sheets/detail/epilepsy. Accessed Jan 18, 2024.
- Fong S, Lim K, Tan L, Zainuddin NH, Ho J, Chia Z, et al. Prevalence study of epilepsy in Malaysia. Epilepsy Research 2021 -01-06;170.
- Waller, Derek. G, Renwick, Andrew G., Hiller, Keith. Epilepsy. Medical Pharmacology and Therapeutics: Elsevier Limited; 2010.
- Ali RA, Fong CY, Lim KS, Tan HJ, Khoo CS, Shaikh MF, et al. Consensus Guidelines on The Management of Epilepsy. 2024.
- Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014 -04;55(4):475.
- Hakami T. Efficacy and tolerability of antiseizure drugs. Ther Adv Neurol Disord 2021 -01;14.
- French JA, Gazzola DM. Antiepileptic Drug Treatment: New Drugs and New Strategies. 2013 -06.