This blog post was submitted by Eisai, the Presenting Sponsor of the November 2019 Epilepsy Blog Relay.
Every person living with epilepsy faces a different journey, but the goal is the same: freedom from seizures. While some patients achieve seizure freedom with their first medication, many more will have to try multiple drugs – oftentimes more than once and at different doses. Switching to a new medication or changing your dose may seem simple but can involve a long process to balance effectiveness with side effects. This balancing act involves the person living with epilepsy, their physician and the support team.
There are many reasons it may be necessary to make changes to a treatment regimen. While most people think about effectiveness and tolerability of the medication first, it is also worthwhile to think about how the medication and dosing schedule fit into one’s lifestyle. Daily schedule changes, increased travel for work, changes during adolescence, or even an over-crowded schedule can impact adherence and how well the medication works in your system. These should all be considerations to encourage a successful shift to a new treatment approach.
What is Dose Mapping
The period during which one is building up to the most effective dose of medication is known as dose mapping or the titration period. This can take several weeks as many drugs need to be titrated at weekly intervals. During this process, the number of doctor visits increases as the care team monitors how well the drug is working as well as how side effects are tolerated. The financial and time burdens associated with additional visits and testing can add stress for patients and their families.
In addition to more time in the doctor’s office, coming off one medication and starting another can take an emotional toll. It is natural to feel frustrated or fearful once it becomes clear that a treatment regimen isn’t working or needs to change. Equally stressful is adjusting to a new treatment schedule and the related worry that a breakthrough seizure can occur while waiting for the new medication to reach its optimal dose.
“When a patient begins a new medication, doctors must take the time to help them adjust to the full dose with minimal side effects. During the time it takes to reach a full dose, the patient is more vulnerable to breakthrough seizures, because the medication is not yet working at full efficacy.” Dr. Barry Gidal, professor of pharmacy and neurology at the University of Wisconsin-Madison, explains that, “In order to manage this increased vulnerability, we will often start a new medication on top of the existing therapy. This means we must partner with our patients to ensure that they understand how the new treatment schedule includes the original medication as well as the new therapy.”
Juggling multiple medications and treatment schedules can make adhering to a new treatment regimen more difficult, so the more rapid the titration schedule, the easier it is to get into a rhythm that supports adherence.
When thinking about dosing, it’s important to remember that not all drugs are the same, and titration periods differ between medications. Some medications may reach a therapeutic dose in four weeks instead of six but require multiple pills a day. It is also possible that a medication with great efficacy has side effects that don’t allow you to live comfortably. These variables must be considered by the care team when starting a new mediation.
Working as a Team
Part of your responsibility in managing epilepsy is to understand how shifting medications needs to fit into a way of life that is realistic for you. If the number of doctor visits associated with a longer titration schedule are difficult in one’s schedule, then talk to your doctor about considering a medication with a more rapid titration schedule or which offers optimum protection from seizures at lower doses.
Be sure to help your doctor understand your personal needs as you consider a new medication so that your physician can work with you on a treatment plan to fit your lifestyle. These “minor” updates (a new weekly activity, change in diet, a new commute) can be incredibly important information for the doctor to have when making treatment decisions and considering dosing schedules.
“Keeping seizure diaries that not only track seizure frequency and severity, but side effects as well, is one the best ways to help physicians identify treatment options that mitigate the risk of breakthrough seizures from the start,” says Dr. Gidal. “It is important for a patient to be his or her own best self-advocate and openly communicate with their health care provider – be that physician, nurse or pharmacist.”
To learn how to discuss the best plan to fit your journey to seizure freedom, check out patient and physician resources on EPILAPSEY.com.