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  • Dr. Cihat Cengiz

Epilepsy in children: change, change and change again

Epilepsie in children

Epilepsy is a brain disorder that affects the nervous system. Almost 800,000 people in Germany suffer from epilepsy - including children. Epilepsy in children is more common than one might think (see also Rolando's epilepsy, which accounts for between 5-15% of all forms of epilepsy in children, babies and newborns). In epilepsy, a distinction is made between symptomatic and idiopathic epilepsy. Epilepsy causes abnormal electrical activity in the brain that can lead to epileptic seizures - the seizure itself can last from a few seconds to several minutes. There are many types of medication for epileptic seizures, all of which can have different side effects. The cause of epilepsy and various seizures, including focal seizures, dissociative seizures, etc., is often unknown. A number of factors may play a role, including genetic factors, abnormalities of brain structure, brain injuries or tumours, toxins, metabolic disorders, infectious diseases or abnormalities of the immune system. It is also known that autoimmunity and inflammation play an important role in the development of seizures. People with autoimmune diseases even have a higher risk of developing seizures.


Seizures in children - change, change and change again

People with epilepsy need treatment as soon as possible after they are diagnosed. Although there is currently no cure for epilepsy, treatment can help control and manage seizures. Treatment for seizures usually consists of anticonvulsants or anti-epileptic drugs. Half of people with newly diagnosed epilepsy become seizure-free with the first epilepsy medication they try. For the rest, especially children, it's try, try and try again: You change the epilepsy medication, get used to the side effects and wait to see if the new medication works. Or you get your seizures under control, but can't cope with the side effects of the new drug.



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Epilepsy: 30% higher probability of seizures due to change of medication...


A recent study has now shown that the risk of having epileptic seizures increases by over 30% when you switch to a drug with the same active ingredient from a different manufacturer.


This may come as a surprise if we are taking the same drug, right? Prof. Hamer of the German Society of Epileptology gave a valid reason why this might be the case. He explained that "different generic preparations contain the same active ingredients, but sometimes differ in the excipients".


Epilepsy in children: Change medication - increase seizures?

Before asking your doctor to switch or stop switching, make sure you are taking the current medication exactly as prescribed. Skipping doses, splitting pills or not following instructions can make a difference. "Even if the dosage form, appearance, size or strength of the tablets changes, there can be mistakes in taking the medication and confusion, which can jeopardise the success of the therapy and lead to an increased risk of seizures," Prof Hamer said in a statement issued by the German Society for Epileptology.

This can affect your control of seizures or side effects. If you follow the instructions exactly but still keep having seizures, talk to your neurologist or epileptologist (an expert in the treatment of epilepsy). They will decide if you should change your medicine. Over time, most people become seizure-free and have minimal side effects when taking epilepsy medication. However, switching medicines takes time and patience. Finding the right medication for you can take equal parts art and science - and sometimes a bit of luck....A jump in the deep end. Even the best doctors don't know which drug is best for a particular person.



Getting a lasting grip on seizures in children

As part of treating your condition, your doctors will try to get an overall picture of you: the type of seizures you have, your age and gender, other medical conditions, medications you are already taking or might take later, and epilepsy medications you have tried in the past.Based on this information, they can narrow it down to a few medications they want to try.

  • Where do you start?

  • What is the switching process like?

It is different for each person. One common factor: success depends on a good partnership between you and your doctor. Switching medicines may involve the following steps:


  1. Your doctor will work closely with you to decide which medicine you should try (next). This will involve a detailed discussion about the pros and cons of the drug, its likely side effects and any rare but potentially serious effects.

  2. 'Double-taking'. Most people start taking the new medicine while still taking the old one. This protects you from seizures until the new medicine takes effect. The dose of the new medicine is increased at weekly intervals.

  3. Stopping the older medicine (or not). Your doctor may tell you to keep taking both medicines for a while. Or he or she may tell you to gradually reduce and then stop the first medicine.


During this time, you and your loved ones should keep an eye out for any seizures, symptoms, side effects and events that affect your well-being and document these with discipline. Unfortunately, the change of medication can take several weeks and is usually not the last change.



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