~Medications~ By far the most common approach to treating epilepsy is to prescribe antiepileptic drugs. The first effective antiepileptic drugs were bromides, introduced by an English physician named Sir Charles Locock in 1857. He noticed that bromides had a sedative effect and seemed to reduce seizures in some patients. More than 20 different antiepileptic drugs are now on the market,all with different benefits and side effects. The choice of which drug to prescribe,and at what dosage,depends on many different factors,including the type of seizures a person has,the person's lifestyle and age, how frequently the seizures occur,and,for a woman,the likelihood that she will become pregnant. People with epilepsy should follow their doctor's advice and share any concerns they may have regarding their medication. Doctors seeing a patient with newly developed epilepsy often prescribe carbamazapine,valproate,or phenytoin (dilantin) first,unless the epilepsy is a type that is known to require a different kind of treatment. For absence seizures, ethosuximide is often the primary treatment. Other commonly prescribed drugs include clonazepam,phenobarbital,and primidone. In recent years,a number of new drugs have become available. These include tiagabine, lamotrigine,gabapentin,topiramate, levetiracetam,felbamate,and zonisamide,as well as oxcarbazapine,a drug that is similar to carbamazapine but has fewer side effects. These new drugs may have advantages for many patients. Other drugs are used in combination with one of the standard drugs or for intractable seizures that do not respond to other medications. A few drugs,such as phenytoin, are approved for use only in hospital settings to treat specific problems such as status epilepticus. For people with stereotyped recurrent severe seizures that can be easily recognized by the person's family,the drug diazepam is now available as a gel that can be administered rectally by a family member. This method of drug delivery may be able to stop prolonged seizures before they develop into status epilepticus. For most people with epilepsy,seizures can be controlled with just one drug at the optimal dosage. Combining medications usually amplifies side effects such as fatigue and decreased appetite,so doctors usually prescribe monotherapy,or the use of just one drug,whenever possible. Combinations of drugs are sometimes prescribed if monotherapy fails to effectively control a patient's seizures. The number of times a person needs to take medication each day is usually determined by the drug's half-life,or the time it takes for half the drug dose to be metabolized or broken down into other substances in the body. Some drugs,such as phenytoin and phenobarbital,only need to be taken once a day,while others such as valproate must be taken more frequently. Most side effects of antiepileptic drugs are relatively minor,such as fatigue,dizziness,or weight gain. However,severe and life-threatening side effects such as allergic reactions can occur. Epilepsy medication also may predispose people to developing depression or psychoses. People with epilepsy should consult a doctor immediately if they develop any kind of rash while on medication,or if they find themselves depressed or otherwise unable to think in a rational manner. Other danger signs that should be discussed with a doctor immediately are extreme fatigue,staggering or other movement problems, and slurring of words. People with epilepsy should be aware that their epilepsy medication can interact with many other drugs in potentially harmful ways. For this reason,people with epilepsy should always tell doctors who treat them which medications they are taking. Women also should know that some antiepileptic drugs can interfere with the effectiveness of oral contraceptives,and they should discuss this possibility with their doctors. Since people can become more sensitive to medications as they age,they should have their blood levels of medication checked occasionally to see if the dose needs to be adjusted. The effects of a particular medication also sometimes wear off over time,leading to an increase in seizures if the dose is not adjusted. People should know that some citrus fruit,in particular grapefruit juice,may interfere with breakdown of many drugs. This can cause too much of the drug to build up in their bodies,often worsening the side effects... Blood Tests Doctors often take blood samples for testing, particularly when they are examining a child. These blood samples are often screened for metabolic or genetic disorders that may be associated with the seizures. They also may be used to check for underlying problems such as infections,lead poisoning,anemia,and diabetes that may be causing or triggering the seizures. Devices The vagus nerve stimulator was approved by the U.S. Food and Drug Administration (FDA) in 1997 for use in people with seizures that are not well-controlled by medication. The vagus nerve stimulator is a battery-powered device that is surgically implanted under the skin of the chest, much like a pacemaker,and is attached to the vagus nerve in the lower neck. This device delivers short bursts of electrical energy to the brain via the vagus nerve. On average,this stimulation reduces seizures by about 20-40 percent. Patients usually cannot stop taking epilepsy medication because of the stimulator,but they often experience fewer seizures and they may be able to reduce the dose of their medication. Side effects of the vagus nerve stimulator are generally mild,but may include ear pain,a sore throat,or nausea. Adjusting the amount of stimulation can usually eliminate these side effects. The batteries in the vagus nerve stimulator need to be replaced about once every 5 years; this requires a minor operation that can usually be performed as an outpatient procedure. Several new devices may become available for epilepsy in the future. Researchers are studying whether transcranial magnetic stimulation,a procedure which uses a strong magnet held outside the head to influence brain activity, may reduce seizures. They also hope to develop implantable devices that can deliver drugs to specific parts of the brain.