Frequently asked questions

What should I do after my very first seizure?

If you have suffered a seizure for the very first time, you should attend the emergency department or contact your general practitioner straight away.

 

 

 

What happens during a seizure?

There are different types of seizure. It is helpful to understand the seizure types and the various signs and symptoms. Below are some descriptions of seizures:

• Tonic-clonic seizure
  This is the most common type of seizure and the easiest to identify.
  The muscles contract forcing the air out of your lungs, your body stiffens and then jerks uncontrollably. Because of the muscles contracting you may let out a cry as you fall down unconscious. For the same reason, you may bite your tongue, be unable to swallow saliva normally, or be incontinent. Your breathing may be irregular; your face may look very pale with a bluish tinge around the lips due to lack of oxygen. The jerking movements nearly always slow down and then stop within five minutes.
  
  A period of drowsiness, confusion, headache and sleep often follows. When you come round you cannot remember what has happened. Recovery time varies.
  
  
  
• Absence seizure
  You stop what you are doing, stare, blink or look vague for a few seconds before carrying on with what you were doing. An onlooker may simply think you are day dreaming or may not even notice, although you may experience many absences a day.
  
  
  
• Other generalised seizures
  Atonic seizures (drop attacks), the muscles suddenly lose their tone causing you to fall heavily to the ground. In Myoclonic seizures, you have brief forceful jerks, similar to those many of us experience as we drop off to sleep.
  
  
• Simple partial seizures
  Abnormal jerking or twitching, numbness, pins and needles, sweating, dizziness, nausea, disturbance of perception and memory such as hearing, vision, smell or taste, things seeming larger or smaller, or feeling that you have been somewhere before (déjà vu) are examples of what you may feel, but there are many others. These may last for several seconds or minutes.
  Simple partial seizures can progress to complex partial seizures or to a generalised seizure. When this happens, these early symptoms can serve as a warning and are known as an aura.
  
  
• Complex partial seizures
  You may behave strangely: you may pluck at your clothes, fumble with buttons, smack your lips, swallow repeatedly, or wander around as if drunk. Such actions are known as automatisms. From time to time they take more unusual forms for instance, some people may undress or behave affectionately to complete strangers.
  
  
• Status Epilepticus
  This is a prolonged seizure or a series of seizures that happen without recovery in between. It is requires urgent medical attention.

 

 

How long do I have to take my medication for?

Usually treatment for epilepsy is prescribed so that you take it over a long time or for life. Your neurologist will discuss with you how long you should take your medication for.

 

 

 

When can I start driving again?

As mentioned above, you are required by law to observe the driving ban for 12 months following your last seizures. More details about driving regulations can be obtained from the Driving and Vehicle Licensing Authority (DVLA).

> Driver and Vehicle Licensing Agency (DVLA)

 

 

 

Can I take the oral contraceptive pill?

Some anti epileptic medications reduce the strength of the oral contraceptive pill. Hepatic enzyme inducing anti epileptic drugs (HEIADs) accelerates the metabolism of the oral contraceptive pill resulting in intermenstrual bleeding and unplanned conception. These are Phenytoin, Carbamazepine, Primidone, Topiramate, Phenobarbitone, Oxcarbazepine and lamotrigine. Topiramate only affects metabolism of the oral contraceptive pill when the daily dose exceeds 200mg. The following anti epileptic medication do not affect the oral contraceptive pill: levetiracetam, gabapentin, sodium valproate, tiagabine, benzodiazepines, pregabalin and Zonisamide.

 

 

 

What contraceptive options are available for women with Epilepsy?

There are several options for contraception using both hormonal and non-hormonal methods. All patients taking hepatic HEIAEDs should be prescribed oral contraception with at least 50mcg of ethinyl oestradiol and even then it may give less protection than for women not taking HEIAEDs. Patients taking non- enzyme inducing drugs should be given a choice from the various standard strength contraceptive pills.

• High oestrogen content (>50mcg) Combined oral contraceptive pill
  There is only one pill on the market with 50microgram oestradiol (Norinyl-1). This should be taken once daily. If a daily single tablet fails to provide adequate contraception as evidenced by inter menstrual bleeding, the patient can be prescribed with two or three packets of the standard strength pill per cycle to be taken simultaneously. Nausea however may occur with these high daily doses.
  
  
• Tricycling
  This option for patients on HEIADs requires them to take three packets of the higher dose oral contraceptive (Norinyl-1), one after the other without a break between them.
  
  
• Progesterone only pill
  It is assumed that HEIADs affect the efficacy of progesterone only pill (POP). A small study recently showed a reduction in progesterone by at least 19% in patients taking Lamotrigine. Women should therefore be advised not to rely solely on the progesterone only pill when taking HEIADs as it may be less effective than the oral combined contraceptive pill.
  
  
• Post coital pill
  Levonorgesterol taken within 72 hours following unprotected intercourse is another option that can be given to women with epilepsy taking anti epileptic medication. The recommended dosing schedule is slightly different for those taking enzyme inducers. The normal dose for Levonelle-2 is 1.5mg (two 750mcg tablets) taken as a single dose. Patients taking enzyme inducers should be prescribed an extra 50% of the usual dose i.e. 3 tablets taken as a single dose.
  
  
• Injectable Preparations
  Medroxyprogesterone injections appear to be effective in women with epilepsy. There is no need to adjust the dosing frequency from the usual 12 weeks to 10 weeks when the patient is taking hepatic enzyme inducing anti epileptic medication as enzyme activity dose not play a part in its metabolism. This option can also be made available to patients taking non-enzyme-inducing drugs. There appears to be no studies on the effectiveness of Noristerat in patients taking anti epileptic drugs.
  
  
• Implants
  Implanon is the only implant available on the UK market following the discontinuation of Levonogesterol implants earlier in the millennium. Implanon is available to patients taking non-HEIADs.
  
  
• Intra-uterine progesterone system
  Mirena, the progesterone releasing system can be made available to patients on anti epileptic medication whether or not they are enzyme inducing. Interactions are less likely to be a problem as the progesterone is released close to the site of contraceptive action i.e. cervical mucus and endometrium.
  
  
• Intra-Uterine device
  This option is suitable for older women and as a second line contraception in young women. There is no risk of interaction with anti epileptic medication.
  
  
• Barrier Methods
  Condoms and other spermicidal contraceptives are not contraindicated in patients taking anti epileptic medication. It is important to emphasise their careful use in order to avoid unplanned pregnancy, which may have distressing consequences, particularly those associated with foetal anomalies, which are high in this population group. It is therefore recommended to take folic acid supplements - 5mg daily for those patients who opt to use barrier methods.

 

 

 

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