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Epilepsy / Medicine

Epilepsy and Drug Switches: Helpful?

pillsA study of epilepsy patients who switched from one antiepileptic drug (AED) to another suggests that the switch did not tend to improve seizure control and may have worsened it.

For epilepsy patients, switching to a different antiepileptic drug (AED) is a common occurrence. The reasons vary; some patients experience only partial seizure control with a given AED, while others find side effects intolerable or worry about long-term consequences of drugs known to cause problems after decades of use.
A team of researchers at Thomas Jefferson University in Philadelphia followed patients who were taking phenytoin or carbamazepine alone as monotherapy for focal epilepsy and were switched to a different AED. The researchers matched each of 43 patients in the “switching” arm to 2 controls of the same seizure status who remained on anticonvulsant monotherapy. The researchers then monitored the participants’ seizure activity for 6 months.

The results, published in the January 2013 edition of Epilepsia, indicated that most patients who were seizure-free remained so after switching to a new AED; just one-sixth had seizures. However, patients who were seizure-free before the switch (ie, those who switched due to side effects or possible long-term consequences) were 6.5 times more likely to experience seizure recurrence than seizure-free patients in the control group, who did not switch medications.

Patients who initially were not seizure-free, however, had the same odds of seizure freedom if they remained on the same drug as they did if they switched. Seizure remission was more likely (but not significantly so) when patients remained on the same drug. Regardless of their pre-switch seizure status, patients who switched from older AEDs to newer agents with different mechanisms of action were no more likely to be seizure-free.

Based on their findings, the authors concluded that most improvements in drug-resistant patients who have focal epilepsy are probably spontaneous remissions rather than responses to new AEDs.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

Source:  www.pharmacytimes.com


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  1. I thought this was very interesting after my 20 years working in the epilepsy field. We do know that after about 5 medications are tried the next one doesn’t stand much of a chance of working.

  2. Switching and building up a tolerance isn’t really the reason of the next medication not working. There are really only two major mechanics with current epilepsy medications. It is true that each time another medication is tried the chances of it working go down about 25% each time after the initial medication (if it was the appropriate one in the first place). It is just what is available today only has that percentage of a chance of working after the first, second, third, etc. med is tried. We do find that sometimes a doctor, that maybe isn’t as well trained in epilepsy, may place someone on the wrong category AED to control the wrong kind of seizures so you have to consider that as well. Combinations of AEDs may work and not switching one of them but adding another to the regimen. I have learned over the years from many specialist that after 5 medications have been tried it usually means that what is left will not work, but, sometimes we see that it does. If not and the person is a VNS or a surgery candidate that is usually the only option left today.

  3. Interesting. They are talking about switching my daughters medication because it “MAY” not be working

  4. yes. many times.

  5. I have been on so many epilepsy meds I stopped counting…

  6. I’m constantly switching my meds as none seem to work and it causes a series of seizures, nightmare!

  7. Ive heard every time you switch meds it knocks the effectiveness rate almost in half for the new meds. They are all chemically based the same way to serve generally the same purpose so tolerance build up/ineffectiveness will progressively get worse.

  8. My daughter is 3 and has been on 4 AED’s. Reading this makes me less hopeful that should one of her meds need to be changed, she doesn’t have a good chance after having tried 5 meds. I know it is different for everyone but still…makes me a little sad. I know she had to be taken off one as a baby because of the side effects.

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