Medical Treatments
Stanford Hospital & Clinics provides access to all available and several experimental antiepileptic medications in the United States. The mainstay of epilepsy therapy centers on the use of these medications - selection of the best medication for the particular patient, and the constant rebalancing of benefit against seizures versus side effects.
Most epilepsy specialists use several principles to govern the treatment of seizures with antiepileptic medications.
Patients often request large supplies of seizure medicines, or extra medicines to take on trips, for emergencies, etc. The medical team is sympathetic to such requests, but it usually is up to the insurance company paying for the pills. Most of the time, third-party payers will allow only one-month supply at a time. Sometimes patients can purchase bulk quantities of medicines. This makes sense once a regimen is well established. This can be renewed. Physicians typically give between 2 - 11 monthly automatic renewals, depending upon frequency of visits and how stable the patient is on a particular medication.
It is one thing to describe the pros and cons of individual medications. It is another to switch from one medicine to another. Even if a seizure medication is not working as desired, removing it can produce withdrawal seizures. Adding any new medicine, no matter how safe in general, introduces an unknown, which could produce unexpected side effects. Therefore, the patient should perceive a clear reason to change medications. Usually these reasons include inadequate seizure control, excessive side effects, or both. Emergence of a new drug on the marketplace is not, in itself, a good reason to initiate a change.
At some point in the development of every promising new drug for epilepsy, it must be tried in people with seizures. If asked to volunteer for a trial of a new drug, you should seriously consider doing so. You will be helping the community of people with epilepsy, and you may help yourself by getting a good new drug that is not available by any other means.
Most seizure medicines are expensive, the exceptions being the old-timers, such as phenobarbital and Dilantin. The newer seizure medicines can cost $300 per month. If a patient is on multiple medications, then cost accumulates to very high levels.
A prescription, traditionally abbreviated as "Rx," is the means by which a doctor communicates with a pharmacy. Prescriptions can be written on pre-printed pads or plain pieces of paper; it is the instructions and doctor's signature that make it legal, not the printing.
These recommendations are solely the opinions of the author, Robert Fisher, MD. Not all medications have an FDA (Food and Drug Administration) indication for the regimen given. A reader with epilepsy should use the "summary information" as a reference source.
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Antiepileptic Drug Selection