If your child is living with epilepsy, you might be given a lengthy list of treatment options. Anti-seizure medication, special diets, implanted devices, surgery — all are potential ways to help keep pediatric epilepsy under control. Having so many choices can give parents and caregivers a lot to think about, and with so many new treatments available, it’s easy to feel overwhelmed.

Partnering with your child’s neurologist to learn about the different paths to becoming seizure-free can help you make the best decisions for your family. Here are five factors to consider when comparing treatment options.

Children need to take anti-seizure drugs on a consistent schedule. Sometimes, medication timing can interfere with school or other daily activities. Talk with your child’s healthcare provider about the best time for treatment and how often your child will need to take medication.

One MyEpilepsyTeam member shared their experience after being diagnosed at age 7 and how adjusting medication timing helped: “Kids can be cruel sometimes if people are different. I changed when my meds were taken from lunchtime to snack at home.”

Other members recalled leaving the lunchroom to visit the nurse and take their medication without their friends noticing.

Some epilepsy treatments also require regular blood tests and lab work. Review these requirements with your child’s doctor in advance so you can plan around important events like school activities, birthdays, and family vacations.

Children and adolescents with epilepsy may be less likely to take their medication if treatment makes them feel like they’re missing out. Planning ahead can help.

Although most seizure medications for children have minimal side effects, your child may experience side effects such as:

• Drowsiness
• Irritability
• Stomach upset
• Rash
• Incontinence (loss of bladder or bowel control)

Knowing about possible adverse effects ahead of time can help you understand what’s going on and describe the symptoms to your child’s doctor, who can recommend the best way to address them.

Members of MyEpilepsyTeam share tips and experiences about starting new medications. “I don’t know the meds your child takes, but some have side effects that cause incontinence,” one member said. “Read more about the side effects.”

You may not be able to avoid all side effects, but it’s important to discuss them with your child’s neurologist and help your child understand what to expect in an age-appropriate way. Side effects like incontinence can be especially upsetting for a child who has outgrown diapers.

As teens get older and transition to adulthood, they should learn that some anti-seizure medications can affect certain types of contraceptives (birth control) and may pose risks during pregnancy. Medications that are most likely to interact with hormonal birth control include:

• Carbamazepine (Tegretol)
• Eslicarbazepine acetate (Aptiom)
• Oxcarbazepine (Oxtellar XR, Trileptal)
• Perampanel (Fycompa)
• Phenobarbital
• Phenytoin (Dilantin, Phenytek)
• Primidone (Mysoline)
• Topiramate (Topamax), depending on dose

Some newer anti-seizure medications have fewer drug interactions with contraceptives, which may make them safer options. However, all medications should be discussed with a healthcare provider because there’s limited research on some newer anti-seizure drugs. Certain birth control options are less likely to be affected by anti-seizure medications, including hormonal injections, implants, hormone-releasing intrauterine devices (IUDs), and copper IUDs.

Some medications may cause weight gain. Others, including felbamate (Felbatol), topiramate, and zonisamide (Zonegran, Zonisade), may promote weight loss. Your child’s doctor can discuss the importance of healthy eating and maintaining a balanced diet.

Being honest with your child when explaining side effects and other aspects of epilepsy to your child can help build trust. Allow your child to ask questions, and answer them as openly as possible. As children become teenagers, encourage them to talk directly with their doctors and take a more active role in treatment decisions.

Understanding how medications can affect your child in the short term is helpful, but it’s also essential to know about the possible long-term effects of different treatment options. For example, restrictive eating plans such as the ketogenic diet may need to be stopped after a set period if they seem to affect your child’s growth and development. When choosing a treatment, you and your child’s doctor will want to make sure the benefits outweigh the risks.

Some anti-seizure medications can affect the liver, kidneys, and blood cells, so regular monitoring and occasional treatment adjustments may be needed. Anti-seizure drugs can also affect bone health, an important consideration for children who need long-term treatment. This risk is higher with some older medicines, including divalproex sodium (Depakote), phenytoin, primidone, and enzyme-inducing anti-seizure drugs such as phenobarbital and carbamazepine.

Newer medications, including levetiracetam (Elepsia XR, Keppra), topiramate, and zonisamide, may have different long-term risks than older treatments. Those risks can vary from one medication or child to another. However, the long-term effects of some medications, including brivaracetam (Briviact) and perampanel (Fycompa), are still being studied.

If possible, share your family’s medical history with your child’s healthcare team. This information can help you weigh the risks and benefits of epilepsy treatment alongside any inherited risk factors for other health conditions. To help support strong bones and possibly lower some treatment-related risks, encourage healthy habits such as:

• Being physically active
• Eating a balanced diet
• Getting enough calcium

Medical devices and epilepsy surgery may help children whose seizures don’t respond to medication. Your child may need to take time away from school and other activities for those procedures, as well as for follow-up visits, device adjustments, or monitoring. Before scheduling a procedure, it’s important to understand not only what happens on the day of treatment but also what recovery and follow-up care may involve in the months and years afterward.

For example, implanted devices used for vagus nerve stimulation require a minimally invasive procedure. To place the device, a surgeon makes a small incision in the chest after giving your child medication to help them sleep and prevent discomfort. Most children go home the same day with only a few stitches, but follow-up appointments are needed to adjust and monitor the device.

Your child’s neurologist may also recommend surgery based on the type of epilepsy, seizure frequency, and other factors. Some procedures use laser technology and may involve a shorter recovery time. Regular follow-up visits after surgery help the doctor assess how well the procedure worked and make sure your child is healing properly.

Be sure to plan for both the procedure itself and any follow-up care your child may need.

No parent wants cost to determine their child’s healthcare decisions. However, insurance coverage is a key consideration for many families.

Start by contacting your health insurance company to find out the costs of medications and procedures recommended by your child’s neurologist. If out-of-pocket costs are still too high, ask your child’s healthcare team about programs and resources that may help. Many drug companies have assistance programs for people who find it challenging to afford medications.

One MyEpilepsyTeam member shared their experience with this type of resource: “My son is able to get his anti-seizure medication directly from the pharmaceutical company that makes it. There are income qualifications, but it’s worth checking out. You may be able to get the meds for free or at a reduced price.”

Depending on your situation, you may qualify for free or lower-cost treatment. By working with your child’s healthcare team, you can explore options that may make treating recurrent seizures more affordable. As epilepsy treatment continues to evolve, parents and caregivers remain a vital part of treatment decisions and ongoing care.

Join the Conversation

On MyEpilepsyTeam, people share their experiences with epilepsy, get advice, and find support from others who understand.

What quality-of-life factors do you take into consideration when treating your child’s epileptic seizure disorder? Let others know in the comments below.