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anti-epileptic drugs

Anti-epileptic drugs (AEDs) are the main type of treatment for most people with epilepsy. Up to 70% (7 in 10) of people could stop having seizures with the right medication. AEDs are a type of medication that aims to stop seizures from happening. They do not stop a seizure once it has started and they cannot cure epilepsy.

Some medications are taken as a ‘course of treatment’ to cure a condition (for example, taking a course of antibiotics for an infection). Anti-epileptic drugs (AEDs) are different; they are a preventative medication taken every day to try and stop seizures from happening. They do this by reducing the excessive electrical activity in the brain that causes seizures. The way they work is not completely understood, and it is likely that different AEDs work in slightly different ways.

What is the aim of treatment with AEDs?

The aim of treatment is ‘optimal therapy’. This means taking the fewest types of AEDs, at the lowest dose in order to get the best seizure control possible with the fewest side effects. If optimal therapy cannot be found with a particular AED there are usually several others that can be tried, alone or in combination.

Two purple pills

How anti-epileptic drugs work

For most people with epilepsy, the treatment for their seizures includes anti-epileptic drugs (AEDs). But what do these drugs do?

When is treatment usually started?

Epilepsy is the tendency to have repeated seizures that start in the brain. Treatment is usually only considered after a diagnosis of epilepsy has been made which usually happens after someone has had repeated seizures. A diagnosis should be made by a specialist preferably with expertise in epilepsy. This is recommended by NICE (the National Institute for Health and Care Excellence).

In some rare situations treatment might be considered after just a single seizure. This is usually only when a doctor thinks that it is very likely that you will have further seizures. If this is the case they may suggest starting treatment straightaway.

Who will be involved with my epilepsy care?

If you or your child have been diagnosed with epilepsy it is likely that you will have seen a neurologist, or a paediatrician or paediatric neurologist. You may already have discussed treatment options with them. They will usually prescribe your AEDs and arrange follow-up appointments to see how you are getting on.

Where we refer to a ‘specialist’ this means a neurologist for adults and a paediatrician for children. Once a child reaches around 16 to 18 years of age they will usually change from seeing a paediatrician to an adult neurologist. This is called ‘transition’.

The day-to-day management of your epilepsy might be under the care of your GP. For example, they might organise your prescriptions. They should also have a copy of your treatment plan so you can talk to them about how you get on.

You might also see an epilepsy specialist nurse (ESN). ESNs work alongside the specialist and GP to help you manage your epilepsy. Not all hospitals have an ESN but you can ask about this at your local hospital.

In the longer term, if your seizures become controlled, you might only see your GP to review your epilepsy each year.

NICE guidelines on anti-epileptic drugs

NICE guidelines on anti-epileptic drugs

NICE guidelines on epilepsy include recommendations for the drug treatment of different types of seizures.

How are AEDs chosen?

There are over 20 AEDs and each has a particular type or types of seizures that it works for. The choice of AED firstly depends on the type of seizures you have, and which AED works for these seizures. NICE has recommendations about which AEDs should be used for different types of epilepsy and seizures.

When a drug is chosen, your specialist will take into account any other conditions you have or medication you take. As you may be on drugs for a number of years they will consider not just what is right for you right now but also for the future. For example, when a girl is first prescribed AEDs they will think about when she becomes an adult and may want to start a family.

Although AED recommendations are largely the same for men and women, children and adults, there are some reasons why a particular AED might be chosen or avoided for a particular person. This may be due to possible side effects. For example, some AEDs can affect concentration more than others so they might be avoided for a student at school or college. Some AEDs can affect an unborn baby while it is developing and so these drugs are usually avoided for girls and women who may become pregnant.

Some AEDs are also used for other conditions such as neuropathic pain or anxiety. These might be recommended for you if you have other conditions alongside epilepsy.

Selection of pills

List of anti-epileptic drugs

Information on all anti-epileptic drugs (AEDs) including dosage and side-effects.

How is treatment started?

Treatment is usually started with a first line AED. This is an AED that is tried first and taken on its own (monotherapy). Once the most appropriate AED for you has been identified, and discussed with you, you will usually start on a very low dose. This helps your body get used to the medication, and makes side effects less likely. The dose is then increased (titrated) slowly over a number of weeks until it stops your seizures. The right dose for you may be different to what is right for someone else and is sometimes referred to as your ‘individual therapeutic concentration’.

How the body absorbs, uses and removes medication changes with age. For children, AED doses are based on their body weight and so the dose increases as they get older (up to around 12 years of age). For adults, doses are not based on body weight.

Getting the right medication

Making sure you are prescribed the same version of your anti-epileptic drugs (AEDs) every time is important for optimum seizure control. Switching from a branded drug to a generic drug, or switching between generic drugs could cause side effects or a breakthrough seizure.

Making sure you are prescribed the same version of your anti-epileptic drugs (AEDs) every time is important for optimum seizure control. Switching from a branded drug to a generic drug, or switching between generic drugs could cause side effects or a breakthrough seizure.

Doctor speaking with patient

Generic and branded anti-epileptic drugs

Getting the same version of anti-epileptic drugs (AEDs) with each prescription may contribute to how well the drug works for that person.

Letter to help you get the same AEDs

We have produced a letter signed by our medical director Professor Ley Sander, supporting your right to be prescribed the same version of your anti-epileptic drugs (AEDs) - unless of course a change is advised for medical reasons. You can download the letter below and give it to your GP, neurologist, pharmacist or healthcare professional. This will help to explain why consistency of medication is important.

Download Letter to your healthcare professional (PDF, 309.44 KB)

How to ensure you are prescribed the same drug

  • Ask your doctor to prescribe by brand name so the pharmacist has to give you that version.
  • If your doctor writes the generic name of the AED on your prescription, ask them to add the name of the specific drug company.
  • Try to go to the same pharmacist each time as they may have a record of your AEDs and may ensure that you receive the same version.
  • Check your AEDs while you are still at the pharmacy. If they are different to the ones you usually take, discuss this with your pharmacist. If you have a smartphone you could use our free smartphone app to photograph your AEDs and show them to your pharmacist.

We have answers to some of the most commonly asked questions about taking AEDs