Finding the right medication depends on the type of epilepsy you have. Not all medicines work on all seizures; the wrong kind could make seizures worse.

Story by: David Steen Martin; Reviewed by Lauren P. Mosier, DNP, APRN on January 8, 2024

Choosing the right epilepsy medication can have a big effect on the frequency of your seizures and your quality of life.

First, finding the right medication depends on what type of epilepsy you have, partial seizures (also called focal seizures) or generalized seizures. All medications don’t work on all types of seizures, and the wrong medication potentially can make seizures worse.

The Food and Drug Administration has approved more than 30 anti-seizure medications, and each has its own advantages and disadvantages.

For example, some anti-seizure medications also can help with migraine or depression, while others may make depression worse. They can cause weight gain or weight loss, require periodic blood tests or may be more likely to interact poorly with another medication you are taking.

“Because anti-epilepsy drugs need to be taken for life, it’s important to find a drug that does the most to eliminate seizures with the fewest possible side effects,” said Lauren P. Mosier, DNP, APRN, with Norton Neuroscience Institute.

Common side effects are fatigue, an upset stomach, dizziness and blurred vision. Many drugs also have rarer, serious side effects such as liver failure, drug reaction rash, or causing suicidal thoughts and behavior.

Anti-seizure medications also can cause issues with attention, memory and concentration.

It’s important to remember side effects vary from person to person. Just because a drug has a potential side effect does not mean you will experience it.

An epilepsy specialist can help you find a medication tailored for your individual needs. The specialist also can help with dosing, especially if you are just starting on an anti-seizure medication.

Starting at a low dose and gradually increasing the dosage often causes many of the side effects to go away over several weeks or months. Even so, the vast majority of people on an epilepsy medication will still experience at least one side effect.

Ideally, a single drug can control your seizures and leave you with tolerable side effects. For 6 in 10 people, the initial anti-seizure medication makes them seizure free.

It’s generally recommended if one anti-epilepsy drug doesn’t work, then a second should be tried individually, when possible — picking a medication that works differently on the brain and body.

You may find your anti-seizure medication works well initially, but the effectiveness wears off over time. With the end of this so-called honeymoon effect, you may need a higher dose, which could in turn worsen the side effects.

An epilepsy specialist can help you weigh the pros and cons of continuing with one medication versus trying another.

Taking a single drug is called monotherapy. Taking two or more anti-seizure drugs is called polytherapy. If your provider recommends polytherapy, it is important that you follow up regularly for monitoring.

If you fail on two or more anti-seizure medications, you can try polytherapy or surgery to combat your seizures. 

Norton Neuroscience Institute Comprehensive Epilepsy Center is nationally recognized as a level 4 center by the National Association of Epilepsy Centers, meaning patients receive the highest level of medical and surgical evaluation and treatment.