After selecting an antiepileptic drug (AED) to initiate treatment, the physician can take a few other steps to maximize the likelihood of a good outcome:

  1. Establish a dialogue
  2. Stress compliance
  3. Request a calendar
  4. Follow up

Establish a dialogue

At the beginning of therapy, establish a dialogue with the patient and family that will increase their understanding of epilepsy and their ability to report important information. Epilepsy affects each patient differently and each patient has a different capacity to understand various aspects of the disorder, so you must tailor the discussion for each individual. This kind of dialogue is essential to ensure that the impact of the condition on the patient's quality of life is clear and everyone understands the expectations of the treatment plan.

Stress compliance

Stress the importance of taking the AED regularly and as prescribed. Give written instructions on how and when to take the AED. Explain the dosing regimen and any potential adverse effects or drug-drug interactions. If the patient is incapable of absorbing this information, explain it to some other responsible person, such as a family member, friend, or case manager.

Compliance with treatment is higher among patients who are well-informed and who understand the expectations of the treatment plan and the potential benefits and risks of therapy. This understanding is particularly important if the medication must be gradually increased during the initial phases of treatment.

Warn the patient not to stop taking the AED suddenly and to be sure to refill the prescription before the pills run out.

Encourage the patient to contact you before starting any other prescription or over-the-counter medication, because the serum levels of the AED could be affected.

Request a calendar

Encourage the patient and family members or friends to keep a calendar and bring it to the office for review at each visit. Items recorded should include:

  • seizures (time of day, symptoms, duration, and severity)
  • medication taken (when and how much)
  • possible seizure triggers (e.g., stress, sleep deprivation, menses)
  • symptoms that may represent side effects (type, severity, time of day)

Keeping a calendar helps to monitor and encourage compliance and may demonstrate whether seizures do correlate with factors such as stress or menses. It also helps track the patient's response to AED therapy, including any side effects.

Arrange follow-up

Schedule follow-up visits as necessary to monitor AED serum levels, blood counts, and liver and renal function, and to address any concerns about the medication or its side effects.

Adapted from: Schachter SC. Treatment of seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 61-74.
With permission from Elsevier (

Authored By: 
Steven C. Schachter
Harvard Medical School
Authored Date: 
Monday, December 1, 2003