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 times every day.

If a generic bioequivalent anticonvulsant drug replaces a brand product, patients (and parents/caregivers if appropriate) should be reassured about equivalent effectiveness, and informed if there are any changes in color or shape.[177]

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 over-the-counter, alternative, or prescribed medications, as some may interact with their anticonvulsant medication and lead to either breakthrough seizures or toxicity.

Patients with active seizures are not allowed to drive. The state driving regulations regarding duration of seizure freedom should be accessed. Epilepsy Foundation: driver information by state 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 from 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 patient's medical doctor may be kept in the 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.[119]

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).

In the US and Canada, pregnant women with epilepsy can enroll in the North American AED (Antiepileptic Drug) Pregnancy Registry, which aims to obtain and publish information on the frequency of major malformations, such as heart defects, spina bifida, and cleft lip, among infants whose mothers had taken one or more anticonvulsants to prevent seizures or to treat any other medical condition. The North American AED (Antiepileptic Drug) Pregnancy Registry Opens in new window

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 labor and birth.[131]

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