Adherence issues

Up to 70 per cent of patients could be seizure-free if they took their medicine as prescribed but the figure currently stands at around 50 per cent, usually due to issues with adherence. One example for missing a dose is if a person has had a seizure and needs to sleep it off for several hours so they miss the next dose. 

Adverse drug reactions are common. If someone is suffering from side-effects it may be possible for them to slow their up-titration to try to give themselves more time for side-effects to settle before the next increase.

Women may have had a change to their contraceptive cover, especially if they are taking valproate, and need to be engaged with the Pregnancy Prevention Programme (PPP). Those planning a pregnancy or who are pregnant will need to take folic acid 5mg daily up until 12 weeks. You can help ensure they understand why these medicines are important and how long they should be taken for. 

Early stages

In the early stages of treatment with their new drug, the person with epilepsy may still continue to have seizures which can lead to them thinking that the new drug isn’t working. This is especially disheartening if they are having side-effects. Each ASM has a usual maintenance dose and it isn’t until the person has been taking at least that dose for a number of weeks before it can be said if the drug is working or not. 

Seizures arise irregularly so it can be hard to tell whether the medication is having an effect or whether it is just that the person isn’t experiencing any seizure activity at that time. Sometimes people forget to take their medicines and, because they don’t have a seizure, they think they no longer need the medication which is very unlikely to be the case.

Sometimes people report that, while they are still having seizures as they up-titrate their ASM, the seizures change, perhaps becoming less intense. This is often a sign that they will respond once the dose is increased so continued medicine-taking can be encouraged.

If starting an ASM triggers more seizures, the person should be referred back to their specialist as soon as possible. Patients could be encouraged to keep a seizure diary, which can help to determine if the medication is working.

Suddenly stopping an ASM can lead to rebound seizures so patients who take medication intermittently can unknowingly be triggering more seizures – another reason for encouraging good adherence where possible. 

OTC medicines and supplements 

Some OTC medicines and supplements can lower the seizure threshold (e.g. some antihistamines, antimalarials) so should be avoided by people with epilepsy. Likewise, other OTC medications might interact, such as sedating antihistamines which could enhance the drowsiness effect of the ASM, or ibuprofen which could enhance the hyponatraemia caused by sodium valproate.