While there is no one-size-fits-all solution for managing seizures, anti-seizure medications (ASMs) are the primary treatment used to control seizures for most individuals living with epilepsy. Medications can help stabilize brain activity and reduce the frequency and severity of seizures. However, finding the right medication can be a process of trial and error, and it may take time to achieve the optimal combination of drugs and dosages. According to a 2021 PubMed research study, 60-70% of patients on anti-seizure medication reach seizure freedom, or go over one year without a seizure, while regularly taking their prescribed doses of medication¹. While it is certainly frustrating that there is no cure or one-size-fits-all solution, it is important to understand how far research has come to get us the medications that are currently on the market to reach a 70% effectiveness rating.  

The ability to treat and understand conditions such as epilepsy has come a very long way over time. Studies show that medications specifically have had a strong increase in efficacy over the last 50 years. Many of the early medications on the market were created to treat other conditions, such as hysteria or insomnia, and a “side effect” of the medication was seizure control in groups who had seizures prior to taking these medications. There wasn’t an official medication to treat seizures until the 1930’s, less than 100 years ago. Dozens of medications have been introduced to the market since, honing in on specific channels within the brain and trying to isolate the root cause of seizures, with limited additional side effects. Thankfully, in 1975 the National Institute of Neurological Disorders and Stroke (NINDS) created the Anticonvulsant Screening Program (ASP) to develop and screen these medications at a much quicker rate².  

While medications are ever-evolving, some of the first-generation anti-seizure medications, such as ethosuximide, created before the 1960’s are still being utilized and are the best fit for certain seizure types. Most prescribed medications today are third generation, having come onto the market since the introduction of the ASP. Popular options such as zonisamide, levetiracetam, lacosamide, and brivaracetam all having been introduced in the last 50 years. In 2015, the ASP became the Epilepsy Therapy Screening Program (ETSP) which has much more stringent processes of evaluation and research techniques to improve medication safety and target specific types of epilepsy.  

Anti-seizure medications are designed to either increase or decrease the electrical activity in the brain. These medications work by affecting neurotransmitters, which are chemicals that help brain cells communicate. Some medications inhibit excessive electrical activity, while others enhance the brain’s ability to regulate normal electrical impulses³. It is important for physicians to select the optimal seizure medication that will prevent seizures with the least amount of side effects or interactions.  

When prescribing anti-seizure medications, doctors should consider several factors: 

• Seizure Type: Not all seizures are the same, and different medications may benefit different types of seizures.  

• Age & Health Condition: Some treatment options may be more suitable for children or elderly patients, while others may be contraindicated for certain medical conditions such as liver disease. There are also special considerations for women who may plan to have children. See our women and epilepsy blog to learn more.  

• Side Effects: Every treatment comes with potential side effects which can vary from mild to severe. Side effects often play a major role in choosing the right treatment plan for an individual.  

• Drug Interactions: Some anti-seizure medications interact with other prescriptions, which can affect their effectiveness or cause harmful side effects.  

A person’s quality of life while on ASD’s should be top priority for their provider, taking into consideration all these factors and making an educated decision on what treatment option to go with.   

Finding the right medication can take time and can often be a long and frustrating process for many patients with epilepsy. It is important for patients to effectively communicate with their providers to ensure that their providers have all of the information needed to make a treatment decision. Patients should not attempt to alter their treatment plan or medication intake without first consulting their provider. In some cases, people with epilepsy may need to combine medications to get their seizures under control. It is important for patients to follow the dosage schedule provided to them for all medications and ensure they are taking all medications on time, every day.  

If you have questions regarding specific treatment options for epilepsy, please speak with your doctor. The information, including text, graphics, images and other material on this website and provided by the Epilepsy Foundation of Northeastern New York, is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. 

If you are interested in learning more about seizure recognition and first aid, please reach out to our team by calling (518) 456-7501 or visiting our website for additional resources.    

Citations: 

(2) Goldenberg, M. M. (2010, July). Overview of drugs used for epilepsy and seizures: Etiology, diagnosis, and treatment. P & T : a peer-reviewed journal for formulary management. https://pmc.ncbi.nlm.nih.gov/articles/PMC2912003/  

(1) Hakami, T. (2021, September 26). Efficacy and tolerability of Antiseizure Drugs. Therapeutic advances in neurological disorders. https://pmc.ncbi.nlm.nih.gov/articles/PMC8481725/#:~:text=The%20appropriately%20chosen%20ASD%20provides,60%E2%80%9370%25%20of%20patients.&text=There%20is%20no%20general%20agreement,years%20from%20the%20first%20seizure.  

(3) Rho, J. M., & White, H. S. (2018, October 24). Brief history of anti-seizure drug development. Epilepsia open. https://pmc.ncbi.nlm.nih.gov/articles/PMC6293064/#:~:text=the%201970s.11-,Anticonvulsant%20Screening%20Program,would%20predict%20efficacy%20in%20humans.