Anti-epileptic drugs (AEDs) are the medications used in the treatment of epilepsy. They are potent medications that act on the brain to prevent/control seizures. The drugs do not cure epilepsy; they improve seizure control and thereby enhance the quality of life for the majority of people with epilepsy. The selection of effective AED therapy is aided by an accurate diagnosis of seizure type's and, if possible,epilepsy syndrome as not all AEDs are effective in the treatment of all types of epilepsy; some may even worsen a person's seizure disorder. Many people with epilepsy are successfully treated with one AED. This is called monotherapy. Some people have seizure types/syndromes less responsive to AED therapy and may require two or more drugs - a process called polytherapy. After an AED is taken orally,it is absorbed from the intestines and passes into the blood stream. The blood transports the drug to the brain where it acts to prevent seizures. The amount of an AED in the blood,and hence the brain,is not constant. The level varies with the rate of absorption of the drug from the gut,its distribution to different parts of the body,its metabolism (i.e. breakdown to inactive components) and its excretion. With continuous medication a 'steady state' situation is eventually reached in which the fluctuation in the blood levels of the drug is relatively small since its rate of absorption is balanced by its rate of metabolism and excretion. For successful treatment,the aim is to produce steady state blood levels of the AED that are in the therapeutic range i.e. levels that will suppress seizures. If drug dosage is too low,the steady state levels that are reached will not be sufficient to produce seizure control in most people. If drug dosage is too high,the control of seizures may be accompanied by side effects such as sleepiness,unsteadiness, tremor,nausea and vomiting,double vision or learning difficulties. These side effects are dose-related and will disappear when the dosage is reduced. It is very important to follow the doctor's instructions about medication in order to achieve the optimal level of the AED in the blood. Levels of some AEDs in the blood are often monitored to aid this process. Some trial and error is inevitable when determining the best treatment program for an individual,since people differ in the way that their bodies handle drugs. In addition,one drug may alter the absorption, metabolism or excretion of another and hence alter the steady state blood levels that are attained. For this reason doctors should be made aware of all the medication (AED or other) that a person is taking and any over-the-counter medications should be discussed with the pharmacist. About 75 per cent of people with epilepsy will achieve good seizure control with AED therapy. About 25 per cent do not respond well to AED therapy but some may be offered other treatments such as surgery. **HOW BEST TO RECORD SEIZURES** Keeping a record of seizures is important. Few doctors ever see their patients having a seizure and they rely heavily on the account of an observer - parent,partner,relative,friend or colleague,in making a diagnosis. There are many different types of seizures,and a precise diagnosis is easier to make if a clear description of the seizures is available. In addition,after diagnosis the doctor will welcome an on-going record of seizures detailing their frequency,and any changes that may occur in the pattern of the seizures or in the seizure type. Such information will help the doctor in prescribing appropriate treatment. If you are caring for a person who has epilepsy you will need to know what to look for. You may miss important details if you do not understand their relevance. Parents may soon grow to recognise the features of epilepsy in their child. Others, such as care staff may look after a number of people with epilepsy who are all affected differently. To ensure consistency of information in such instances it may be advisable to develop a standard form of recording seizures. **SEIZURE STAGES** There may be several stages in a seizure and each should be carefully observed and recorded. Build up and onset This may last for several days in the form of a build-up of tension,or for only a few minutes. In some instances an 'aura' or warning (a partial seizure) consisting of odd sensations such as an unpleasant smell,tingling feeling or 'butterflies' in the stomach may precede a major convulsive seizure. The seizure This may be one of many types. Each seizure is individual to the person who has it. The period after the seizure Recovery may be immediate or may take a few hours. On rare occasions effects may last for as long as a few days, particularly in the case of an elderly person. After major convulsive seizures there is often confusion and drowsiness and sometimes unsteady gait, headache, or slurred speech. What was the date of the seizure? What was the exact time of day? What was the person doing at the time? Had the person just fallen asleep, or woken up? What called your attention to the seizure (a cry, fall, stare, head-turn)? Did the seizure progress slowly or quickly? How long did each stage of the seizure last? What parts of the body were affected? Was one side affected more than the other? Did the body become stiff? Did it jerk, twitch or go into convulsions? Was the person unconscious? If not, was there any alteration in awareness? Did the skin show changes (flushed, clammy, signs of blueness)? Did the breathing change? Did the person talk or perform any actions during the seizure? Was the person incontinent of bladder or bowel? Did the person vomit during the seizure? Did any injuries result from the seizure? How did the person behave after the seizure (alert, drowsy, confused)? After recovery did the person remember any unusual sensations before or at the onset of the seizure? How long did the person take to recover completely? If the person takes medication, when was the last dose before the seizure? Anything else associated with the seizure you think the doctor should know? If you can answer all these questions you will provide a very full picture of the person's epilepsy. A complete account such as this can be very useful at the onset of epilepsy or at times of change (e.g. a change in medication, or a change in the pattern of seizures). At other times it may only be necessary to keep a summarised record: Date Time of Day How long seizure lasted Description of seizure and other information to be discussed with the doctor