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Epilepsy – Medication Treatment

February 13, 2022


Epilepsy has multiple potential treatments. When we look at patients with seizures and epilepsy, we have a few different modalities of treatment that we can consider. The first is medication and as the first line treatment for epilepsy, I would point out that when we, when we’re choosing a drug for somebody and choosing how to treat them, about 60% of patients will respond to medication. And another 30% to 40% will continue to have seizures despite medication treatment. We’ll talk about things besides medications next, but I’ll focus on medications first. With respect to medications, there are a lot of different choices. We’re looking at over 20 different medications for epilepsy and for seizures. I would point out that often we call these antiepileptic drugs. Really at the end of the day, they’re anticonvulsants. There’s no one drug better than the next. They’re all, as far as we can tell, roughly equally effective. And so what we’re often doing, as neurologists and epilepsy doctors, is trying to pick the right drug for you. And I have unfortunately no way of knowing that 100%. I have to take the available data, but at the end of the day we’re taking a leap of faith as far as how you’re going to respond. The other thing that we sort of don’t always know the answer to is what’s the right dose? And I get a lot of patients who come back sort of unhappy sort of feeling like, oh that doctor keeps throwing pills at me and just one thing after another. And the issue there is I don’t know and not only do I know exactly the right drug for you, I’m going to make an educated guess based on a lot of data that I’ve got. But I also don’t know what the right dose is for you. So what we ended up doing is we pick a medication, we start at a relatively low dose and we sort of hope it works. And, you know, it sounds kind of crazy that it’s that blinded and we have that little information, but we really don’t. Oh, we can get levels of medications, but that doesn’t always tell me if you’re going to respond. I don’t know what level is right for you.

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