Weakened nerve endings, sudden changes in breathing, and the feeling as if you’re going through an out-of-body experience encapsulate the struggles of living with seizures. Patients may find it difficult to control these random attacks, especially if medicines need to taken more than once a day. Now, a study to be presented at the American Academy of Neurology’s 68th Annual Meeting in Vancouver, Canada, suggests a once-a-day epilepsy drug may prevent seizures just as well as a twice-a-day drug.

"Seizure control is crucial," said study author Elinor Ben-Menachem, MD, of Gothenburg University in Gothenburg, Sweden, and a member of the American Academy of Neurology, in the statement. "A once-a-day drug [eslicarbazepine] may help people stick to their medication schedule."

Currently, twice-a-day-drug carbamazepine is the first choice for patients with partial, generalized tonic-clonic and mixed seizures. The drug is used alone or in combination with other medications to control seizures in patients with epilepsy by reducing abnormal electrical activity in the brain, according to Medline Plus.

Typically, the human brain works by sending electrical signals through neurons, which are nerve cells. However, when a seizure occurs, there's a surge in this activity. This leads to physical symptoms, such as muscle contractions, visual disturbances, and blackouts. Patients with partial seizures — either simple or complex — just experience them in one area of the brain.

“Simple partial seizures often start in the hippocampi or the temporal regions,” Dr. Ram Nageshwar Rao Angara, a general practitioner, told Medical Daily. Meanwhile, complex partial seizures have a “unilateral involvement of the cerebral hemisphere.”

For example, if the disturbance is in the part of the brain that affects vision, the patient may have hallucinations or see bright lights.

To determine whether these seizures can be effectively prevented, Ben-Menachem and her colleagues sought to determine the efficacy and safety of eslicarbazepine for 815 newly diagnosed adults with partial seizures, in comparison to twice-daily controlled-release carbamazepine over a 26-week period. Eslicarbazepine has been approved by the U.S. Food and Drug Administration for partial seizure treatment, either used alone or in combination with other anti-seizure drugs.

The participants received the drugs for about six months, and started the study at the lowest of the three dosing levels of each drug — eslicarbazepine 800 milligrams (mg) or carbamazepine 200 mg. Those who had a seizure at the lowest level were then moved up to the second dosing level — eslicarbazepine 1200 mg or carbamazepine 400 mg. If they had another seizure, they received the highest dosing level — eslicarbazepine 1600 mg or 600 mg carbamazepine.

The findings revealed a total of 71 percent of those taking eslicarbazepine and 76 percent of those taking carbamazepine were seizure-free after six months. After one year, 65 percent of those taking the once-daily drug were seizure-free compared to 70 percent of those taking the twice-daily drug.

The promise of a once-a-day drug could help patients, particularly new ones, manage the disease better. The researchers note memory issues, fatigue, or a complicated medication schedule do influence how often a patient takes their medication. It’s common for people with epilepsy to miss a single dose once in a while, but missing one dose is more likely to cause seizures if it’s supposed to be taken only once a day. Missing several doses in a row increase the likelihood of a breakthrough seizure, according to the Epilepsy Foundation.

Ram warns that high-grade fevers and head injury trigger seizures in epileptic patients, and that the more often these factors are in play, the more seizures someone will encounter. Moreover, the side effects of these anti-seizure drugs are dependent on dose.

“Their [side effects] frequency varies in relation to type of drug and its dosage (i.e., sedation and cognitive effects are more frequent with barbiturates, benzodiazepines and topiramate) and patient’s characteristics (i.e., elderly patients are more susceptible to cognitive effects and motor coordination disturbances, whilst children more often develop behavioral effects),” he told Medical Daily.

In general, patients can control seizures effectively with medications and lifestyle changes. Within the first year of being diagnosed, about 50 to 60 percent of people will be seizure-free after using the first seizure medication tried. Side effects are still likely to occur with anti-seizure drugs.

A once-a-day drug may help patients keep track of their illness and ease their symptoms.

Source: Ben-Menachem E. “Once-a-day epilepsy drug may prevent seizures as well as twice-a-day drug.” American Academy of Neurology’s 68th Annual Meeting in Vancouver, Canada. 2016.