Women with epilepsy may need to change medicines to stop seizures, to enhance the quality of the life for the woman or to protect the baby of a pregnant woman. There are numerous drugs available at this time, and at least at this time, the dose in any pill in the generic drugs is unacceptably too high. Side effects can occur if the doses vary too much from pill to pill. Dr. King-Stephens discusses these issues in detail, using the example of Kepra.
For any individual, we don’t know which medicine is best without trying it. The concern is that these medicines will be needed for long periods of time and we don’t necessarily know the full battery of side effects –especially long-term side effects — associated with all these medicines. Anti-seizure medicines are affected by other medicines such as anti-depressants. For example, lomictil may need to be increased when birth control pills are added. Changing doses or not needing to change must be evaluated in the context of the whole person – age, sex, other medicines, other illnesses, etc. If there is a seizure, the best care is associated with getting a blood level of the anti-seizure level. Some of the drug interactions may take two to three months to develop before breakthrough occurs and by then, some people forget about the change. Genetic information is also becoming available that may help predict the potential for bad drug side effects, leading to even more personalized care.