Epilepsy is a neurological disorder caused by abnormal electrical brain activity in the brain that results in seizures. How people experience seizures and their epilepsy can change greatly over time. Take a patient whose seizures initially include a sudden loss of consciousness, with convulsions that last around a minute. The patient experiences short term memory loss with a long recovery time, which can last from 20-30 minutes. There is a great risk of a concussion during these episodes. At the time, this is diagnosed as generalized epilepsy.
A couple years later, the durations of the seizures shorten to about 30 seconds, and the recovery time decreases. More importantly, the patient reports having auras before losing consciousness and having convulsions. Auras are warning signs that the body gives before the person loses consciousness, decreasing the risk of injury and concussion. Auras can take the form of visual cues, strange smells, feeling tingling in a certain area of the body, or even déjà vu. The seizures occur far more frequently, and the triggers are difficult to identify.
Perhaps the change in the nature, frequency, and pattern of the seizures indicates whether the condition is worsening or progressing. Or maybe it means that there is no change in the severity of the epileptic’s condition. It turns out that seizures changing from the day an epileptic is diagnosed is a common occurrence, but how and why would this occur? There are multiple explanations, and researchers are constantly discovering more factors involved in the way seizures manifest.
Were the new medications prescribed responsible for this evolution in these epileptic episodes? Many individuals switch between different seizure medications for a multitude of reasons: side effects, allergic reactions, a long history of breakthrough seizures, and a willingness to try something new. Could changes in medication affect the nature, frequency, and pattern of the seizures? The switch between generic and name brand anti-epileptic drugs is a controversial issue. Despite the US Food and Drug Administration (FDA) approving the use of generic drugs, many doctors advise against it (Gagne et al., 2015). There are disagreements with the FDA’s conclusions, more specifically with their standard bioequivalence range used for generic and name brand drugs. The standard bioequivalence range is a metric utilized to determine whether or not the generic is just as effective as the name-brand version. There are also some studies and organizations that claim that the switch from generic to brand-name anti-seizure medication is less effective: the Epilepsy Foundation of Metro New York writes that generic medications are 10-20% less effective when delivered to the brain (Nouri, 2012).
According to a 2015 study approved by the Institutional Review Board at Brigham and Women’s Hospital conducted by Gagne et al., researchers found that “for every 1000 person years of treatment for patients who begin treatment with a generic AED (anti-epileptic drug), there would have been 34 fewer seizure-related hospitalizations and ER visits than if they had begun treatment with a brand-name version instead” (Gagne et al., 2015). Gap-free treatment days were defined as the treatment-free days between using a generic drug and a brand-name drug. The study offers many limitations, such as not being able to monitor different factors that affect seizure rates such as sleep deprivation and alcohol or drug use. In addition, the study only looks at older patients, so they do not get a sense of diverse epileptic activity over a variety of age groups. This study is significant because it is looking at how generic and brand-name anti-epileptic drugs affect the frequency in hospitalizations and emergency room visits. More importantly, the frequency in hospitalizations and emergency room visits used in the study are effective ways of measuring the frequency and severity of seizures that can change over time, depending on the type of anti-epileptic drug.
Despite its limitations, this study suggests that using generic drugs can be just as effective, if not even more effective than brand-name anti-epileptic drugs. Medications for epilepsy is an area that is still being studied, but there are encouraging signs that patients are receiving, for the most part, effective drugs, whether they are generic or brand-name.
Changes in the nature and frequency of seizures may also have to do with the decrease of anti-epileptic drugs in the body. This may happen as the result of beginning a new medication, and one example is birth control for women. Birth control for women contains both estrogen and progesterone, and there are also progesterone-only contraceptives. Estrogen is known to worsen seizures while progesterone is a hormone that can improve seizures. When there is a hormonal imbalance and decrease in progesterone in the body, this can cause disturbances in the brain as well as seizures. If the estrogen hormone shifts the balance and is more favored at the time of menstruation, then seizures can worsen and occur more often (Nouri, 2012). These are known as catamenial seizures and affect almost 40% of females with epilepsy. In other words, with hormonal imbalance, epileptic women are more likely to get seizures just before or during their menstrual cycle.
There are also other factors that can increase the severity of epilepsy, including other conditions like strokes, head trauma, and obstructive sleep apnea. Furthermore, changes in behaviors such as alcohol consumption and recreational drug use can negatively affect seizures. There are medications that are also known to increase the frequency of seizures and “lower the seizure threshold” including certain antibiotics like ciprofloxacin or levofloxacin (Nouri, 2012).
As with any condition, from the day someone is diagnosed, that person is set on a quest for wellness. Sometimes we find that it’s the things that are not entirely obvious that may play a role in what exacerbates a problem. With epilepsy, there are many elements that are thought to increase the severity or frequency of seizures, and many of these factors are even considered important to health, whether it be birth control, antibiotics, or anti-epileptic drugs themselves. When living with any chronic illness, it’s crucial to always observe, to be critical, to be mindful, but more importantly, to step back and ask: “What’s happening now? What’s changed? What’s different?” When you start looking forward, you find answers.
About the Author
Renneanna Dillen is a junior at Harvard College studying Neuroscience.
References
Gagne, J. J., Kesselheim, A. S., Choudhry, N. K., Polinski, J. M., Hutchins, D., Matlin, O. S., Brennan, T. A., Avorn, J., Shrank, W. H. (2015). Comparative effectiveness of generic versus brand-name antiepileptic medications. Epilepsy and Behavior, 52, 14-18. https://www.natap.org/2016/HIV/2015_cer_generics_brands_antiepileptic_drugs_epilepsy_and_ behavior.pdf Nouri, Shahin. (2012, July). When Seizure Types Change Part I. Epilepsy Foundation Metro New York. http://epilepsynyc.com/2012/07/when-seizure-types-change-part-i/
A couple years later, the durations of the seizures shorten to about 30 seconds, and the recovery time decreases. More importantly, the patient reports having auras before losing consciousness and having convulsions. Auras are warning signs that the body gives before the person loses consciousness, decreasing the risk of injury and concussion. Auras can take the form of visual cues, strange smells, feeling tingling in a certain area of the body, or even déjà vu. The seizures occur far more frequently, and the triggers are difficult to identify.
Perhaps the change in the nature, frequency, and pattern of the seizures indicates whether the condition is worsening or progressing. Or maybe it means that there is no change in the severity of the epileptic’s condition. It turns out that seizures changing from the day an epileptic is diagnosed is a common occurrence, but how and why would this occur? There are multiple explanations, and researchers are constantly discovering more factors involved in the way seizures manifest.
Were the new medications prescribed responsible for this evolution in these epileptic episodes? Many individuals switch between different seizure medications for a multitude of reasons: side effects, allergic reactions, a long history of breakthrough seizures, and a willingness to try something new. Could changes in medication affect the nature, frequency, and pattern of the seizures? The switch between generic and name brand anti-epileptic drugs is a controversial issue. Despite the US Food and Drug Administration (FDA) approving the use of generic drugs, many doctors advise against it (Gagne et al., 2015). There are disagreements with the FDA’s conclusions, more specifically with their standard bioequivalence range used for generic and name brand drugs. The standard bioequivalence range is a metric utilized to determine whether or not the generic is just as effective as the name-brand version. There are also some studies and organizations that claim that the switch from generic to brand-name anti-seizure medication is less effective: the Epilepsy Foundation of Metro New York writes that generic medications are 10-20% less effective when delivered to the brain (Nouri, 2012).
According to a 2015 study approved by the Institutional Review Board at Brigham and Women’s Hospital conducted by Gagne et al., researchers found that “for every 1000 person years of treatment for patients who begin treatment with a generic AED (anti-epileptic drug), there would have been 34 fewer seizure-related hospitalizations and ER visits than if they had begun treatment with a brand-name version instead” (Gagne et al., 2015). Gap-free treatment days were defined as the treatment-free days between using a generic drug and a brand-name drug. The study offers many limitations, such as not being able to monitor different factors that affect seizure rates such as sleep deprivation and alcohol or drug use. In addition, the study only looks at older patients, so they do not get a sense of diverse epileptic activity over a variety of age groups. This study is significant because it is looking at how generic and brand-name anti-epileptic drugs affect the frequency in hospitalizations and emergency room visits. More importantly, the frequency in hospitalizations and emergency room visits used in the study are effective ways of measuring the frequency and severity of seizures that can change over time, depending on the type of anti-epileptic drug.
Despite its limitations, this study suggests that using generic drugs can be just as effective, if not even more effective than brand-name anti-epileptic drugs. Medications for epilepsy is an area that is still being studied, but there are encouraging signs that patients are receiving, for the most part, effective drugs, whether they are generic or brand-name.
Changes in the nature and frequency of seizures may also have to do with the decrease of anti-epileptic drugs in the body. This may happen as the result of beginning a new medication, and one example is birth control for women. Birth control for women contains both estrogen and progesterone, and there are also progesterone-only contraceptives. Estrogen is known to worsen seizures while progesterone is a hormone that can improve seizures. When there is a hormonal imbalance and decrease in progesterone in the body, this can cause disturbances in the brain as well as seizures. If the estrogen hormone shifts the balance and is more favored at the time of menstruation, then seizures can worsen and occur more often (Nouri, 2012). These are known as catamenial seizures and affect almost 40% of females with epilepsy. In other words, with hormonal imbalance, epileptic women are more likely to get seizures just before or during their menstrual cycle.
There are also other factors that can increase the severity of epilepsy, including other conditions like strokes, head trauma, and obstructive sleep apnea. Furthermore, changes in behaviors such as alcohol consumption and recreational drug use can negatively affect seizures. There are medications that are also known to increase the frequency of seizures and “lower the seizure threshold” including certain antibiotics like ciprofloxacin or levofloxacin (Nouri, 2012).
As with any condition, from the day someone is diagnosed, that person is set on a quest for wellness. Sometimes we find that it’s the things that are not entirely obvious that may play a role in what exacerbates a problem. With epilepsy, there are many elements that are thought to increase the severity or frequency of seizures, and many of these factors are even considered important to health, whether it be birth control, antibiotics, or anti-epileptic drugs themselves. When living with any chronic illness, it’s crucial to always observe, to be critical, to be mindful, but more importantly, to step back and ask: “What’s happening now? What’s changed? What’s different?” When you start looking forward, you find answers.
About the Author
Renneanna Dillen is a junior at Harvard College studying Neuroscience.
References
Gagne, J. J., Kesselheim, A. S., Choudhry, N. K., Polinski, J. M., Hutchins, D., Matlin, O. S., Brennan, T. A., Avorn, J., Shrank, W. H. (2015). Comparative effectiveness of generic versus brand-name antiepileptic medications. Epilepsy and Behavior, 52, 14-18. https://www.natap.org/2016/HIV/2015_cer_generics_brands_antiepileptic_drugs_epilepsy_and_ behavior.pdf Nouri, Shahin. (2012, July). When Seizure Types Change Part I. Epilepsy Foundation Metro New York. http://epilepsynyc.com/2012/07/when-seizure-types-change-part-i/
