Adjunctive therapy for epilepsy, also known as adjuvant therapy, is the use of more than oneantiepileptic drug (AED)to preventseizures. Often, the only way to achieve adequate seizure control is through the use of complementary therapy.
Complementary therapy has advantages and disadvantages, and you can talk with your doctor to discuss the best options for treating epilepsy. This article will review available complementary treatments and how they are used.
Complementary treatments for epilepsy
Monotherapy is the use of a single drug to treat one condition. Some AEDs are not indicated for monotherapy and are approved only as adjunctive therapy.
Those that are approved for adjunctive therapy only may improve seizure control when used in combination with one or more AEDs, but are not expected to prevent seizures when used alone.
Drugs approved only for use as adjuvant AEDs include:
- Briviact (brivaracetam): Approved as adjunctive therapy forprevent partial-onset seizures(starts in one part of the brain), with and without secondary generalization (spreads widely in the brain), for adults and children 1 month of age and older
- Neurontin (gabapentin): Approved as adjunctive therapy to prevent partial-onset seizures with and without secondary generalization for adults and children 3 years and older
- Zonegran, Zonisade (zonisamida): Approved for adults and children 16 years and older as adjunctive therapy to prevent partial seizures
- Banzel (rufinamida): Approved for adults and children 1 year and older as adjunctive therapy to prevent seizures fromLennox-Gastaut syndrome
- Lyrica (pregabalina): Approved as adjunctive therapy to prevent partial-onset seizures in adults and children 1 month of age and older
In addition, many anti-epileptic drugs that can effectively control seizures when used alone can also be combined with other anti-epileptic drugs.
For example, AEDs such as Lamictal (lamotrigine), Felbatol (felbamate), Fintepla (fenfluramine) andTopamax (topiramate)It can be used as monotherapy or as adjunctive therapy. And some AEDs are approved as a monotherapy for some conditions and as a complementary therapy for others.
Maintenance treatment versus emergency treatment
Adjunctive treatment of epilepsy is generally considered maintenance therapy to prevent seizures. Other fast-acting AEDs are used toemergency seizure treatment. You may need one or more AEDs to control seizures in an emergency situation.
Aptiom (Eslicarbazepina) - Oral
When is adjuvant treatment used?
Often, the treatment of epilepsy begins with monotherapy. Monotherapy is usually effective for most people who have a seizure disorder.
Depending on your control of seizures and side effects with monotherapy, your doctor may consider adding another adjunct AED medication for you in some circumstances.
Reasons to consider adjunctive epilepsy treatment:
- Monotherapy is partially effective. You may experience a decrease in the number and/or severity of your seizures with monotherapy. But if you still have some seizures, your doctor may prescribe an additional AED to better control your seizures.
- Side effects of monotherapy are intolerable. You can have good seizure control with an AED, but its side effects may require a dose reduction. If the reduced dose is inadequate to prevent your seizures, your doctor may prescribe an additional AED.
- You have different types of seizures.. If you have different types of seizures, such as a combination ofabsence crisisyfocal seizures, an AED will likely be effective in treating one type but not the other. Your doctor may prescribe more than one AED in this situation.
- There is a risk of drug interactions. If you are starting a new medication that may interact with your current monotherapy AED, your doctor may change your seizure prevention treatment to avoid interactions. The best option for you may be a combination of AEDs rather than just one.
You and your doctor will discuss the choice between switching from one monotherapy to another monotherapy or using an adjunct therapy based on your specific situation.
Epilepsy Physician Discussion Guide
Get our printable guide to your next doctor's appointment to help you ask the right questions.
Pros and cons of adjunctive treatment of epilepsy
Your doctor will discuss with you the anticipated effects of adjunctive therapy for epilepsy if you need to take an additional AED.
Potential benefits of additional therapy for epilepsy include:
- Improved seizure control: There are more than 20 AEDs with various mechanisms of action. Sometimes using drugs that prevent seizures with different mechanisms can be more effective than using a drug that only works with one antiseizure mechanism.
- less side effects: You may be able to take lower doses of various AEDs when using additional therapy. By doing this, you will be able to get enough seizure control without having some of the side effects that can develop from taking a high dose of an AED.
- Management of problems unrelated to epilepsy: Some AEDs can treat conditions other than epilepsy. For example, Lyrica and Neurontin can be used to treat certain types of pain. You may experience multiple health benefits from using certain supplemental AEDs.
Possible disadvantages of additional therapy for epilepsy include:
- Drug interactions: some drugs have chemical reactions that change the action or concentration of other drugs when used together. Taking multiple AEDs with different chemical compositions can increase the risk of drug interactions.
- different side effects: AEDs can have side effects, and when you take more than one AED you may be exposed to a wide range of possible side effects.
- amplified side effects: Many AEDs have some of the same side effects, especially tiredness, dizziness, and difficulty concentrating. Taking multiple AEDs that produce the same side effects can make these problems serious.
- Complicated dosing scheme: It can be difficult to take more than one medication, especially if they are taken several times a day or at different times. Some medications need to be taken with food, while others need to be taken without food, and this can make things even more complicated for you.
If you start taking adjunctive treatment for epilepsy, your doctor may gradually adjust the doses of the anti-epileptics you are taking to reach a therapeutic level with minimal side effects.
Adjunctive treatment without medication
In general, the most common adjunctive treatment for epilepsy is AED medication. Sometimes, however, other complementary approaches are needed to control epilepsy.
Dietary modifications can sometimes be beneficial in preventing certain types of seizures. When used to treat drug-resistant epilepsy, theketogenic dietit is designed as a high-fat, low-carb diet.
Other lifestyle strategies, such as using herbs or supplements, have not been shown to prevent seizures, either alone or in combination with AEDs.
Can a gluten-free diet treat epilepsy?
Adjunctive therapy for epilepsy involves using more than one drug to control seizures. Drugs may be specifically approved as an add-on therapy, while others may be used as a monotherapy or add-on therapy.
Although monotherapy is effective for most people with epilepsy, adjunctive therapy may be needed to prevent side effects and achieve better seizure control.
A Word from Verywell
Adjunctive epilepsy medication is often prescribed for optimal seizure control. If you are prescribed more than one AED, be sure to take the medications as prescribed and let your doctor know if you experience seizures.
Also, it's important to familiarize yourself with the side effects of each medication you take so that you can let your doctor know if you start to experience any. In addition to medication, avoiding epilepsy triggers (alcohol, sleep deprivation, not eating, and flashing lights) is also an important aspect of epilepsy treatment.
Causes and prevention of seizures
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Brigo F, Lattanzi S, Igwe SC, Behzadifar M, Bragazzi NL.Additional treatment with zonisamide for focal epilepsy.Cochrane database system Rev.July 24, 2020;7(7):CD001416. doi:10.1002/14651858.CD001416.pub5
Panebianco M, Prabhakar H, Marson AG.Additional treatment with rufinamide for refractory epilepsy.Review of the Cochrane database system. 25 de abril de 2018;4(4):CD011772. doi:10.1002/14651858.CD011772.pub2
ByDra. Heidi Moawad
Heidi Moawad is a neurologist and an expert in the field of brain health and neurological disorders. doctor Moawad regularly writes and edits health and career content for medical books and journals.
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