Q&A with Dr. Fred Lado

NEXT UP: Part II of “Switching Seizure Medications”

 by Patricia McGoldrick, NP, MPA, MSN

 

 

The team at EFMNY would like to thank you for your questions! After each post, we’ll post answers from our experts to the most frequently asked questions we receive.  Please note that these Q&A post, like our provider articles, should not be taken as medical advice.  Each patient is unique.  For medical advice regarding your specific condition, please consult your doctor.

 

Q&A with Dr. Fred Lado:

1. I lost my driver’s license due to seizures. If I switch medications or add a new medication, how long will it take to demonstrate that I can drive? Is the decision up to my doctor or the State?

The rules that govern whether and when an individual may drive are set by each state (Click HERE for more information). In New York State, individuals are required to be seizure free for 12 months before they may drive. If a seizure occurred because an individual reduced a medication on the orders of a doctor, it may be possible to resume driving sooner (after receiving approval of the NY Dept. of Motor Vehicles). Switching medications does not alter the time an individual may not drive.

2. I am now on two medications, and I’ve been doing better. I still have seizures every 3 or 4 weeks. Is it risky to add a third medication at this point?

The biggest improvement in seizure control usually occurs after starting the first medication. The second medication will also usually make a noticable difference in seizure control. The third medication may also help, but less than the first two. Taking more than three medications is unlikely to improve seizure control, but may increase side-effects. The chance of side-effects, particularly drowsiness, increases with each added medication. Most side-effects are reversible, meaning they will go away after reducing or stopping the new medication. There is always a chance of rare side-effects when starting a new medication, but one has to balance the risk of further seizures against the low risk of a rare side-effect. (more…)

Switching Seizure Medications: Part I

When should you consider switching medications?

There are two circumstances when one should consider changing medications, when the medication is not completely effective in stopping seizures, and when the medication is producing unacceptable side effects.  Cost of a medication may also be a reason one must consider switching to less expensive medication.  One should not, however, switch from a well-tolerated and effective medication to a different medication just to try the newest medication, or in response to advertising, or on the advice of a friend or acquaintance, since the effectiveness and side-effects of the new medication are difficult to know in advance and may result in worse seizure control or new side effects. For those individuals taking one or two medicines who are still having seizures, your doctor may recommend adding a seizure medication rather than switching from one medication to another.  Taking more than three seizure medications, however, rarely improves seizure control but often results in more side effects. For individuals taking two or three medications, switching out one medication to try another medication is the usual recommendation.

What are the risks of switching medications?

Switching medications involves risks, namely the possibility that seizure control will worsen, or that the new medication will cause unanticipated side-effects.  Since usually one is undertaking a medication switch because of either poor seizure control or side-effects, it is sometimes difficult to know whether the possible benefit of changing medications outweighs the risk.  This is a very individualized decision, since each individuals lifestyle and seizure type are important factors.  For example, if one individual has seizures occurring several times a month, then the benefits of a medication switch outweigh the risks of worsening seizure control, since seizure control is already poor.  On the other hand, if another individual has a seizure once every 1 to 2 years, then the risk of worsening seizure control is a greater concern.  One may still want to change medications to achieve complete seizure control, for example, to obtain a driver’s license. However, this individual and their doctor may approach the switch more gradually, first adding the new medication to the old one, and then after sufficient time – even 1 or two years – gradually tapering the older medication. (more…)

When Seizure Types Change: Part II

Treatment

If in fact an evaluation has been made that confirms your seizure type has changed you may need to change medications. If you are now having seizures when they had previously been controlled it may mean that the medication you were taking does not work for the type of seizure you are now having.

A thorough evaluation is needed, as discussed in the previous blog, which will provide information about your new seizure type, why you are having a new seizure type, what this means in terms of controlling your epilepsy; and it will aid in choosing treatment.

Medications are usually the first line of treatment for seizures. They are chosen based upon seizure type. Your medication may need to be changed or a new medication may need to be added if your seizure type has changed.

Other things to think about when choosing a new medication are:

• previous response to medications of the same class,
• your age,
• gender,
• weight, allergies,
•  and possible interactions with other medications that you are taking.

  (more…)

Q&A with Dr. Akila Venkataraman

NEXT UP: Part I of “When Seizure Types Change”  by Dr. Shahin Nouri

 

The team at EFMNY would like to thank you for your questions! After each post, we’ll post answers from our experts to the most frequently asked questions we receive.  Please note that these Q&A post, like our provider articles, should not be taken as medical advice.  Each patient is unique.  For medical advice regarding your specific condition, please consult your doctor.

 

Q&A with Dr. Akila Venkataraman:

 

1. I was diagnosed with epilepsy at age 9 and I’ve continued to have seizures for more than a decade in spite of seeing a number of doctors and taking several medications. My parents and siblings are all healthy. Why are some people predisposed to have seizures while others are not? I’ve never even had a head injury.

While many people who have seizures may have a family history of epilepsy, having seizures depends mostly on the nature of an individual’s brain cells. Some people have been found to have genes that make them more susceptible to having seizures than others, even if they are otherwise healthy.

2. You mentioned the social implications of being unable to drive due to seizures. I’ve been seizure free for 8 months, so my doctor cleared me to drive again. I was thrilled, but now every time I get behind the wheel, I’m paralyzed. I’m so afraid that this could be the day it comes back. How can I be sure I won’t have another seizure while driving? (more…)

What is Uncontrolled Epilepsy?: Part II

When epilepsy is uncontrolled, it indicates the continued occurrence of an unacceptable quantity of seizures despite reasonable treatment. The amount of seizures deemed unacceptable is dependant on the nature of the seizures, the patient’s lifestyle and the consequences of such uncontrolled seizures.

So, what does uncontrolled epilepsy translate to in real life? What does uncontrolled epilepsy mean to those who are affected by it?

Continuing to experience seizures despite treatment, otherwise defined as intractable or refractory epilepsy, becomes a disability. Life becomes limited and circumscribed. (more…)

What is Uncontrolled Epilepsy?: Part I

It seems simple: either a person’s seizures are controlled or they are not.  However, what does it mean to have controlled seizures?  To an Epilepsy Specialist, controlled seizures mean that the seizures have stopped.  Uncontrolled seizures are ones which continue, even though the person has tried one (or many) medications.  Surprisingly, many people come to their doctor, believing that their seizures are “under good control”.  To that person, “good control” might mean that the seizures are “much better than they used to be.”  However, even if the person is having one seizure per year, their seizures are uncontrolled. (more…)

Next Entries »