How Long After Starting Epilepsy Medication Will Seizure Frequency Decrease?

How long after starting medication for epilepsy does it typically take to reduce the frequency of seizures?

Hello Doctor: My family member is currently 54 years old and began experiencing absence seizures about four to five years ago.
In the past one to two years, they have had approximately one tonic-clonic seizure per year, and typically experience complex partial seizures once or twice a day.
Since the second half of last year, the frequency of seizures has increased to complex partial seizures occurring once a day.
They have never had any head trauma, and after examinations, aside from abnormal EEG results, no clear cause has been identified.
Brain imaging results have also shown no abnormalities.
They started treatment last year and are currently taking Lamotrigine once in the morning and once in the evening, and have been taking Zolpidem at night for sleep issues for about six months.
However, they still experience complex partial seizures one to two times daily.
I would like to ask the doctor, how long after starting medication can we expect to see a significant decrease in seizure frequency for epilepsy patients? Additionally, how should we discuss medication management with the doctor after starting treatment? Thank you, Doctor, for your assistance.

Ling, 20~29 year old female. Ask Date: 2022/01/28

Dr. Jiang Junyi reply Neurology

Dear Ms.
Ling,
You mentioned that "my family member started treatment last year and currently takes one dose of Levetiracetam in the morning and evening.
They have been taking Zolpidem at night due to sleep issues for about six months, but still experience one to two complex partial seizures daily." Generally, about 20-30% of epilepsy patients may experience seizures three months after starting medication.
During outpatient visits, we usually inquire whether the medication is taken regularly and whether the patient is avoiding known seizure triggers, such as sleep deprivation, irregular lifestyle, and alcohol consumption.
If none of these factors are present, it may indicate that the dosage is insufficient, and it may be necessary to increase the dosage to a tolerable level or consider switching to another medication or adding an additional medication.
This suggests that the patient's epilepsy may be more difficult to treat than others.
I recommend consulting a neurologist who specializes in epilepsy for further evaluation and treatment.
Thank you for your inquiry, and feel free to discuss any related questions.
Wishing you good health and peace.
Dr.
Chien-Yi Jiang, Taoyuan Medical Center

Reply Date: 2022/01/28

More Info

When it comes to the management of epilepsy, particularly in adults, the timeline for seeing a reduction in seizure frequency after starting medication can vary significantly based on several factors, including the type of epilepsy, the specific medication used, and individual patient characteristics. Generally, many patients may begin to notice a decrease in seizure frequency within three to six months of starting an appropriate antiepileptic drug (AED). However, it is important to note that this is not a universal timeline, and some patients may require a longer duration or adjustments in their treatment regimen to achieve optimal control.

In your case, your family member has been experiencing complex partial seizures daily, despite being on medication for about six months. This situation indicates that the current treatment may not be adequately controlling the seizures. It is crucial to consider several factors that could influence the effectiveness of the treatment:
1. Adherence to Medication: Consistent and correct usage of the prescribed medication is vital. Missing doses or not taking the medication as directed can lead to breakthrough seizures.

2. Medication Dosage: The dosage of the medication may need to be adjusted. Sometimes, the initial dose is not sufficient to control seizures, and titration to a higher dose may be necessary, provided it is tolerated well by the patient.

3. Drug Interactions: If the patient is taking multiple medications, as in your case with the addition of sleep aids, there could be interactions that affect the efficacy of the antiepileptic drug.

4. Underlying Conditions: Other medical conditions, lifestyle factors (such as sleep patterns, stress levels, and substance use), and even dietary habits can influence seizure control.

5. Type of Epilepsy: Different types of epilepsy respond differently to various medications. If the current medication is not effective, it may be worth discussing alternative medications or combinations of medications with the healthcare provider.

In terms of discussing medication status with the physician, it is essential to have open and honest communication. Here are some tips for that discussion:
- Document Seizure Activity: Keep a detailed seizure diary noting the frequency, duration, and nature of each seizure. This information can help the physician assess the effectiveness of the current treatment.

- Discuss Side Effects: If there are any side effects from the medication, these should be communicated to the doctor, as they may influence adherence to the treatment plan.

- Inquire About Alternatives: Ask about the possibility of adjusting the current medication dosage or switching to a different AED that may be more effective for your family member's specific type of epilepsy.

- Follow-Up Appointments: Regular follow-up appointments are crucial for monitoring the condition and making necessary adjustments to the treatment plan.

- Seek a Specialist: If the current neurologist or healthcare provider is not providing satisfactory results, consider seeking a second opinion from an epilepsy specialist or a neurologist who focuses on seizure disorders.

In conclusion, while many patients may see a reduction in seizure frequency within three to six months of starting treatment, individual responses can vary widely. Continuous monitoring, open communication with healthcare providers, and a willingness to adjust treatment strategies are key components in effectively managing epilepsy. If your family member continues to experience frequent seizures, it is critical to revisit the treatment plan with their healthcare provider to explore further options.

Similar Q&A

Managing Seizures During Antiepileptic Drug Transition: What to Expect

I have epilepsy, with no history of brain injury or family history of the condition, and the cause is unknown. I have been treated with Depakote for nearly two years. Recently, my liver enzymes have shown an upward trend, and after discussing with my physician, I switched to Lamo...

Dr. Cai Zongzhang reply Neurology
Hello: There are many types of seizure patterns in epilepsy. It is recommended to record the frequency and types of seizures, and discuss appropriate adjustments with your physician during follow-up visits.

How Long Does It Take for Keppra to Control Seizures?

Hello Doctor: I have already learned some information about Keppra from the Q&A, but I haven't seen anyone ask how long it typically takes for this medication to achieve the effect of suppressing abnormal discharges (I am currently taking 500mg in the morning and 500mg i...

Dr. Cai Zongzhang reply Neurology
Hello: There is a certain degree of variability in how each individual absorbs this medication, making it difficult to determine exactly how long it will take to achieve its effects. Generally, initial use requires several weeks of dosage adjustments and observation. Any antiepil...

Can Epilepsy Medication Be Reduced After One Year Without Seizures?

My father has had unexplained epilepsy symptoms that have not recurred for a year and a half. I am wondering if the medication dosage can be reduced. Previously, at another facility, we did not receive any response from the physician. If we visit your hospital, will we need to un...

Dr. Huang Yingzhe reply Neurology
Director Huang Ying-Che of the Neurology Department at Tainan Hospital, Ministry of Health and Welfare, replies: Generally, if there have been no seizures for 2 to 3 years and the EEG results are normal, it is possible to consider reducing or even discontinuing medication. Theref...

Managing Epilepsy: Recognizing Relapse After Medication Withdrawal

Hello, Dr. Tsai. I have focal epilepsy and underwent an EEG examination two and a half years ago. My symptoms include headaches and occasional forgetfulness regarding unimportant matters. After receiving medication treatment, my EEG results have been normal for over two years, so...

Dr. Cai Zongzhang reply Neurology
It is recommended to discontinue the medication after an evaluation by a neurologist, and the method of discontinuation should be discussed with the physician.