Patient discussions

Provide patients with clear written instructions about medications and dosing. Patients often need to be reminded that they should take their medications at the same time every day.

If a generic bioequivalent anticonvulsant drug replaces a brand product, patients (and parents/carers if appropriate) should be reassured about equivalent effectiveness, and informed if there are any changes in colour or shape.[176]

Encourage sufficient sleep and regular sleeping patterns, as sleep deprivation may trigger seizures in some patients.

Advise patients to check with their epilepsy doctor before starting non-prescription, alternative, or prescribed medications, as some may interact with their anticonvulsant medication and lead to breakthrough seizures or toxicity.

Patients with active seizures are not allowed to drive. Driving regulations regarding duration of seizure freedom should be accessed. Epilepsy Action: driving and epilepsy in the UK: the rules Opens in new window

Explain to patients that they should not work from heights, operate heavy machinery, or engage in activities that might put them at risk of injury resulting from a seizure.

Advise patients with active epilepsy to exhibit caution with regard to swimming and bathing. Drowning is the most common accidental death in people with epilepsy. Therefore, they should not swim alone; a lifeguard or qualified buddy should be present. Extreme-contact sports should probably also be avoided.

A medical alert bracelet providing information about the patient's medical condition may be helpful. Alternately, a card with the patient's medical condition, the name and doses of medication, and the details of the patient's doctor may be kept in a wallet.

If discontinuation of anticonvulsant medication is being considered for patients who have been seizure-free for 2 years or more, discuss the risks and benefits of discontinuation with the patient (and their family if appropriate), including the risks of seizure recurrence and treatment resistance. Individual patient characteristics and preferences, including quality of life considerations, should be taken into account.[164]

Contraception and pregnancy

Education about effective contraceptive options and potential adverse pregnancy outcomes should start in early adolescence and continue throughout a patient's reproductive life, because anticonvulsant medication, contraceptive needs, and desire for pregnancy are likely to change over time.[118]

Inform women of childbearing potential that they must follow a pregnancy prevention program while on treatment with valproic acid and its derivatives. Some countries may also require that a pregnancy prevention program is in place for other anticonvulsants (e.g., topiramate).

Inform women that:

  • Being seizure-free for at least 9 months before pregnancy is probably associated with a high rate of remaining seizure-free during pregnancy

  • If they smoke they may have a substantially increased risk of premature contractions and premature labour and birth.[130]

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