Achieving control of seizures is not an easy process – it involves trial and error for each patient to find the right AED at the right dose to control symptoms. The BNF suggests a number of factors that influence the choice of AED³ the seizure type, the epilepsy syndrome, any concomitant medication or comorbidities, age and gender. Once an appropriate treatment is found and control achieved the patient should be able to lead a symptom-free life.

Anything with the potential to disrupt seizure control is likely to cause anxiety and distress to the patient. The fear of loss of control itself can be debilitating; patients need to have confidence in the medication they are taking in order to lead a full and active life. Seizures themselves are also distressing for patients and their carers. They can put the patient at additional risk of physical injury due to falls, convulsions and a lack of awareness of surroundings. Sadly, every year a small percentage of epilepsy sufferers die during or shortly after a seizure.

One of the most notable effects of the loss of seizure control is the impact on permission to drive a car. Patients with epilepsy may drive a car provided that they have been seizure-free for one year. This automatically implies that a patient is not permitted to drive for one year following a seizure. The DVLA also recommends that patients should not drive during medication changes or withdrawal of AEDs and for six months afterwards.⁴ Anyone suffering a breakthrough seizure must inform the DVLA who will review the seizure type and are likely to revoke their licence. The inability to drive will likely have serious consequences for a person's livelihood, lifestyle and quality of life.

Secondary to a loss of seizure control is the risk of an increase in side effects due to a raised plasma concentration of AED. Common side effects of AEDs, particularly the older generation of drugs, are dizziness, drowsiness, sleep disturbances and mental confusion. Choice of AED is frequently influenced by side effect profile often with a number of drugs being tried to find the one best tolerated by the patient at effective doses. In a patient whose treatment is stabilised, the return of side effects can be a worrying development and could impact on adherence to treatment. In addition, any attempts to titrate the dose to reduce side effects could in turn lead to loss of seizure control.

³ BNF 77 March- September 2019 Chaper 4 Section 2 Epilepsy control
⁴ DVLA - Epilepsy and Driving - https://www.gov.uk/epilepsy-and-driving