Epilepsy

What are the causes of epilepsy ?

Seizures happen when the brain’s electrical activity changes. It is not clear what causes these bursts of activity. Sometimes they are a result of a brain injury caused by:

• alcohol
• birth trauma
• brain tumour
• drug or alcohol misuse
• head injury
• infection
• stroke

Seizures may have a trigger like stress, tiredness or alcohol, but sometimes they happen randomly.

What are the symptoms of epilepsy ?

Seizures are the main symptom of epilepsy. There are different types of seizure.

• Simple partial seizures
• Complex partial seizures
• Tonic-clonic seizures
• Absence seizure
• Myoclonic seizure
• Clonic seizures
• Tonic seizures
• Atonic seizures
• Status epilepticus

How does a doctor diagnose epilepsy ?

Your GP will usually refer you to a neurologist if you have a seizure. It may be some time before it is confirmed whether or not you have epilepsy. Your neurologist may want to speak with someone who was with you when you had a seizure, and they may find it helpful to see a video of your seizure.

There are some tests your neurologist can commission, including an EEG. This will check for unusual brain activity. An MRI or other type of brain scan might be recommended, too. This will show brain tumours, damage caused by a stroke or any scarring on the brain.

What to do if you think you have epilepsy

If you have a fit or a seizure and you have never had one before, or you are under investigation for epilepsy, see a doctor as soon as possible. It is best to get yourself checked out, and also to get the details of the seizure noted on your health records.

Is an epileptic seizure or fit an emergency?

People who have had epilepsy for a long time may prefer to manage their seizures without help from the emergency services. It can help to familiarize yourself with seizure first aid, as recommended by the Canadian Epilepsy Alliance.

If the person having a fit has breathing problems or has injured themselves, get medical help by calling 911. Other reasons to call an ambulance are:

• the fit has lasted for more than five minutes
• the person has had several seizures in a row
• the person has never had a fit before

How will a doctor treat my epilepsy ?

The aim of epilepsy treatment is to reduce the number of fits or seizures a person has, or prevent them completely. A neurologist will first try anti-epileptic drugs to control seizures. If this doesn’t work, surgery may be an option, or an electronic device that changes electrical activity in the brain.

Some people living with epilepsy can avoid seizures by reducing exposure to seizure triggers.

Anti-epileptic drugs (AEDs)

There is an extensive range of anti-epileptic drugs. Your neurologist will take into account things like your age, what kind of seizures you have and other factors when prescribing AEDs.

Some meds prescribed for epilepsy may take a few weeks to work and you might have seizures in this period. Keep taking your meds, even if they don’t seem to be working. Your neurologist may start you on low dose and gradually increase it. If a single med doesn’t work to control your epilepsy, your neurologist will try a combination of drugs.

It’s best to take your anti-epileptic drugs according to the instructions your doctor has given you and in the same way each day – for example, at the same time of day, and with or without food.

Side-effects of anti-epileptic medications

Anti-epileptic drugs may have side-effects including:

• nausea
• dizziness
• sleepiness
• tiredness
• diarrhea
• depression
• loss of appetite
• weight loss
• tremors
• headaches
• feelings of irritation

You can learn about expected side-effects of your meds by checking the patient information leaflet, or by asking your doctor. Side-effects often go away by themselves once your body gets used to your medication.

But some meds have more serious side-effects, for example, suicidal thoughts and signs of liver problems like yellowing of the whites of the eyes. Ask your doctor about the signs of serious side-effects linked to your meds, particularly in the early days of your treatment or if you’ve changed to a new medication. They will tell you what signs to look out for and what to do if you spot them.

You may need to take your AED drugs for many years, and your neurologist can try different regimes if something is not working. If any side-effect troubles you, do not stop taking your anti-epileptics. Talk to the healthcare team looking after you, or your pharmacist. They can help you adjust your anti-epileptic regime.

Can I take anti-epileptics with other meds?

When you take anti-epileptics with other medicines or nutritional supplements or herbal preparations they may interact in unexpected ways. Ask your neurologist and pharmacist about any other meds and preparations that you have been prescribed or would like to take.

Is it safe to get pregnant if I am taking anti-epileptic drugs?

Some AEDs are not safe to take during pregnancy, for example, sodium valproate. When these drugs are prescribed for you, if there is a chance you could become pregnant, you will need to use a reliable form of contraception even if you are not sexually active.

If you would like to try to conceive, or you think you might be pregnant, do not stop taking your meds before speaking with your neurologist. It is important to maintain control of your epilepsy to keep your baby safe. Your neurologist will help you to adjust your medications so you can have a safe pregnancy, while managing your condition.

Can I breastfeed while taking anti-epileptic drugs?

There is a good range of AEDs that you can safely take while breastfeeding. Talk with your neurologist so that you can find an epilepsy control regime that is safe for you and your baby. Trusted infant feeding website Kellymom has resources to help you with decision-making and risk assessment around managing long-term conditions with medication while breastfeeding.

What drugs are used to treat epilepsy?

Some examples of anti-epileptic drugs are:

• sodium valproate
• carbamazepine
• lamotrigine
• levetiracetam
• topiramate
• clobazam
• ethosuximide
• gabapentin
• pregabalin

Sodium valproate

Sodium valproate is also available as Dyzantil, Epilim, Episenta and Epival. It is not suitable for people who are pregnant or trying to conceive. Sodium valproate is available in various formats, including slow-release tablets, capsules and granules, gastro-resistant tablets, crushable tablets, and as a liquid. Take sodium valproate with or without food.

Carbamazepine

The AED carbamazepine is also available as Tegretol and Curati. It is used to treat epilepsy and is available as slow-release tablets, a liquid and suppositories. Carbamazepine interacts with grapefruit, so avoid this juice while you are taking this medication.

Lamotrigine

Lamotrigine is prescribed for epilepsy. It works by slowing down electrical signals in your brain. There is a branded version called Lamictal. It comes in tablets to swallow, or tablets that you can chew or dissolve in water that you then drink.

Levetiracetam

Levetiracetam is a medicine used to treat epilepsy. It is also available as Desitrend and Keppra. You can get it as tablets, liquid or granules.

Topiramate

Topiramate (also available as Topamax) reduces the bursts of electrical activity in your brain that can cause seizures. You can get topiramate as tablets, capsules or liquid.

Gabapentin

Gabapentin is also sold as Neurontin. It reduces abnormal electrical activity in the brain. You can get it in various formats – tablets, capsules and liquid. If you need to stop taking gabapentin, it is important to do it gradually to mimize withdrawal symptoms.

Pregabalin

The anti-epileptic drug pregabalin is available as Alzain, Axalid and Lyrica. It can have an effect on your blood sugar, so if you have diabetes and you have been prescribed pregabalin for epilepsy, discuss with your diabetes nurse or doctor.

Other meds used to control epilepsy

Your neurologist might also prescribe clobazam or ethosuximide to help manage epilepsy.

Will you send me the same brand and format of my epilepsy medicine every time?

Although all the different manufacturer’s versions of a drug with the same generic name should be bioidentical, in some cases neurologists recommend a particular manufacturer’s version of epilepsy meds. And many people prefer to manage their epilepsy with a specific format of their medication, for example, liquid, tablet or granules. We will do our best to meet these requirements. Tell us if something doesn’t seem right about the meds you have been sent. You can also ask your doctor if you have any questions.

What should I do if I miss a dose of my anti-epileptic drugs?

If you miss a dose of your meds, follow the instructions on the patient information leaflet. Talk with your doctor if you are at all concerned about missing a dose of your AEDs.

Some people have problems remembering to take their meds, and if this sounds like you, ask for advice. There are various methods you can use to manage a complex medication regime, including dosette boxes, reminders and apps.

What happens if I take to much of my anti-epilepsy meds?

If you take too much of your anti-epileptic drugs, seek medical advice. If you need to go to ER, take the packet, meds and patient information leaflet with you.

How do I get medications for epilepsy ?

In Canada you can depend on NX Pharmacies for your epilepsy meds. We serve all areas of Canada and can fill your prescription of epilepsy medication. We can help with renewals and refills. Our discretion is assured, and you can depend on us for authentic Health Canada-approved medications.

Brain surgery for epilepsy

If it is not possible to control your epilepsy using medications alone, brain surgery may be considered if your fits are caused by abnormal activity in a small part of your brain.

Other epilepsy procedures

Two other procedures used for epilepsy control are:

• vagus nerve stimulation
• deep brain stimulation

These both involve small devices like a pacemaker that change electrical signals in the brain.

Ketogenic diet for epilepsy

Before AEDs were widely available, a ketogenic diet that is high in fats and low in carbohydrates was used to reduce the number of seizures. It is sometimes recommended for children if their seizures can’t be controlled by AEDs, but only if supervised by a dietician and epilepsy specialist. This type of diet is not much used for adults because it is linked to diabetes and cardiovascular disease.

How to manage epilepsy with lifestyle changes

Your GP may recommend some lifestyle changes to reduce the number of fits you have and support your regime of epilepsy meds. Ask for support if you need help with implementing any of these changes.

Take your epilepsy meds

To get best control of your epilepsy it is important to take your epilepsy meds as prescribed. It may take some time for an anti-epilepsy regime to start working, so keep taking your prescribed AEDs, even if nothing seems to have changed. You and your neurologist may also need to try several drugs or combinations of drugs before you find one that works. So, patience and persistence are key in managing epilepsy.

Epilepsy meds are powerful drugs with wide-ranging effects. Do not stop taking them without discussing it with your neurologist. If you miss a dose, check the patient information leaflet with your meds and get advice from your doctor if necessary.

Attend your epilepsy check-ups

At your epilepsy appointment your doctor will check that your meds are working as expected and you will have a chance to ask questions about side-effects that you might be experiencing with your epilepsy medication.

Even if you’ve been successfully managing your epilepsy for years, you can still benefit from the support of a doctor or pharmacist.

If something changes with your epilepsy , talk to your GP. And if your meds stop working, or you start to get uncomfortable side-effects, ask for a medicines review. Your pharmacist may also be able to advise on managing side-effects of your epilepsy meds.

Avoid things that trigger your epilepsy

If you know what triggers your epilepsy, it may be possible to make lifestyle changes so you avoid it. For example, if you know that heavy drinking triggers seizures, then reduce your alcohol intake.

Some people have a seizure if they get too tired. The Public Health Agency of Canada has some advice on improving sleep. Poor sleep is also linked to chronic stress, which can be a trigger for seizures, too. So think about causes of stress in your life and take steps to deal with them.

Safety and epilepsy

Seizures may put you or others at risk of harm. For example, a driver who has a seizure could cause a traffic accident. While your epilepsy is poorly controlled, take steps to reduce the danger. For example, take a shower rather than a bath and avoid locking the bathroom door.

You friends and family may wish to get training in epilepsy first aid.

The Canadian Epilepsy Alliance has advice about driving and epilepsy.