The principal mode of treatment for epilepsy is with medication called anti-epileptic drugs (AEDs). They are also referred to as anticonvulsant drugs.
Despite their name, AEDs do not “cure” epilepsy or seizures. They do not change the brain’s underlying susceptibility to produce seizures. Most AEDs also do not change the child’s EEG, except for a few specific conditions. They only treat the symptoms of epilepsy by reducing the frequency of seizures.
There are many AEDs available on the market and new ones are in development. Which medication is used depends on the condition and the child being treated. Medication treatment must be tailored specifically to suit each situation.
For certain syndromes, other types of medications may be used, either alone or in combination with AEDs. For example, a steroid called cosyntropin zinc hydroxide (ZH) suspension (Synacthen Depot) is sometimes used to treat a specific type of seizures in young children, infantile spasms.
When reading the information in this section, remember that the information we have about AEDs comes from clinical trials and past experience. These tell us what has happened and what is likely to happen in terms of effects, side effects, and so on, but they cannot tell us for certain what will happen to your child.
Although there is a good chance of success, AEDs do not always work. At the start of treatment, it is impossible to tell for certain whether a child will benefit from the treatment or not. Studies indicate that AEDs are most effective in children who began having seizures when they were less than 12 years old, who did not have neonatal seizures, who have normal intelligence, and who had fewer seizures before beginning treatment.
Generally, medication is tried first before trying other forms of treatment. Other forms of treatment are usually only tried if medication fails to reduce the seizures or produces unacceptable side effects. Surgery for seizures may be recommended earlier if the cause of seizures is identified to be a brain lesion that is growing, such as a tumour.
For most children, medication is all that is needed to control seizures. A Nova Scotia study of 417 children with generalized tonic-clonic and partial seizures (with or without secondary generalization) found that for 83% of the children, the first AED successfully controlled their seizures. Some of the remaining 17% gained seizure control on another AED or a combination of AEDs.
When to use AEDs
AEDs are usually not given at the first sign of a seizure. Half the children who have one seizure never have another. However, a second seizure greatly increases the chance of having more seizures, so treatment is usually considered at this point. In many cases, AEDs are very effective: 20% of children on AEDs never have another seizure, and others will have them only occasionally. However, it is impossible to tell for certain at the start of treatment whether an AED will stop a particular child from having seizures.