Know about medicines

Levetiracetam is the ingredient; Keppra is a brand example. Match the brand, formulation and strength on the pack to its official Australian PI or CMI. Do not change or stop treatment independently.

Match treatment to seizure type and syndrome, then weigh comorbidity, interactions, organ function, reproductive circumstances, treatment burden and the person’s goals. Record the rationale and planned review.

NICE NG217 · seizure-specific treatment ↗

No. NICE lists lamotrigine or levetiracetam as first-line focal-seizure monotherapy. Comparative trial evidence informs selection, but does not make every levetiracetam prescription inappropriate. Apply Australian approval and local guidance.

NICE NG217 · seizure-specific treatment ↗

Review actual use, benefit, tolerability, interactions and effects on daily function. Ask specifically about mood, sleep, cognition, family planning and treatment preferences. Agree who will act on the findings and when.

NICE NG217 · treatment and monitoring ↗

Confirm the indication and ongoing benefit. Review actual use, renal function, tolerability and mood or behavioural changes. Distinguish the original acute-care indication from the rationale for continued treatment. Consult current PI for prescribing details.

Australian Government Medicine Finder · levetiracetam ↗

Ask which seizure type or epilepsy syndrome the medicine is intended to treat. Other considerations include age, reproductive plans, other conditions, interactions and previous response. A medicine comparison helps structure the conversation, but a list of advantages cannot predict how you personally will respond.

• Write the reason for choosing it and the agreed treatment goal.
• Ask when benefits and tolerability will be reviewed.

Supporting source ↗ · SANAD II · focal epilepsy trial ↗ · SANAD II · generalised / unclassified epilepsy trial ↗

Record the active ingredient, brand if relevant, strength, formulation, prescribed times and prescriber. Include non-epilepsy medicines, supplements and allergies. A photograph can help identify packaging, but a photograph alone is not a verified current prescription. Check changes with the pharmacist before updating your list.

• Use the pharmacy label and your current prescription as the starting point.
• Bring one up-to-date list to every clinician and pharmacy.
• Record who confirmed a change and the date.

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Ask in advance for instructions specific to each medicine. What to do depends on the formulation, timing and clinical situation; do not use one generic rule for all drugs. Do not double a dose unless your clinician’s medicine-specific plan expressly directs that action. If you cannot retain medicines or are running out, contact your pharmacist or treating team promptly.

• Agree a refill reminder before the supply becomes urgent.
• Use a checked organiser or routine if helpful.
• Ask whether storage, crushing or swallowing changes are safe for that formulation.

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A useful review looks at both seizures and everyday function. Keep a short record of sleepiness, balance, concentration, mood or other problems and when they started. Do not assume that every new symptom is caused by medicine, or dismiss a symptom simply because it is not common.

• Record start dates and prescribed changes beside symptoms.
• Describe the effect on work, study, relationships or sleep.
• Contact the prescriber for persistent or troublesome adverse effects.

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Read the serious adverse-effect section of your exact medicine leaflet and ask the pharmacist to explain it. Severe allergy symptoms, collapse, major breathing difficulty or rapidly worsening illness need emergency assessment. A new rash, particularly with fever, blisters or mouth/eye involvement, needs urgent medical advice.

• For a medical emergency in Australia call 000.
• Take the medicine list or packaging with you.
• Obtain urgent clinician instructions about further doses when a serious reaction is suspected.

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Check with a pharmacist before adding or stopping any prescription, over-the-counter or complementary product. Some antiseizure medicines affect contraception, and hormonal treatment can affect some antiseizure medicine levels. Pregnancy planning needs a specific medicine review; stopping treatment abruptly after a positive pregnancy test can create serious risk.

• Tell every prescriber you take antiseizure medicine.
• Ask about reproductive plans even if pregnancy is not imminent.
• Keep pregnancy advice medicine-specific rather than relying on a category letter alone.

TGA · pregnancy precautions ↗ · Supporting source ↗ · Supporting source ↗ · Supporting source ↗

A breakthrough event should prompt review of what happened, whether it was epileptic, the medicine taken, interactions, adherence barriers and the treatment plan. Persisting seizures are not a personal failure. Ask whether an epilepsy specialist review or additional assessment could clarify the next options.

• Report new seizure types and injuries.
• Discuss affordability, supply or side-effect barriers openly.
• Do not add leftover medicines or borrow another person’s treatment.

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Being seizure-free does not mean medicine can automatically stop. Discuss recurrence risk, the epilepsy syndrome, driving implications and personal priorities with the prescriber. If a change is agreed, obtain a written schedule, instructions for recurrence, and a follow-up date. Do not improvise a taper or restart an old schedule.

• Ask what should happen if symptoms recur.
• Check whether work, travel or conception plans affect timing.
• Make sure all clinicians and the pharmacist have the final regimen.

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SANAD II supports lamotrigine as an important first-line option for newly diagnosed focal epilepsy, but it does not show that another drug cannot be the right choice for an individual. In generalised and unclassifiable epilepsy, valproate performed better than levetiracetam on important trial outcomes; its reproductive risks can change the choice substantially. Childhood absence epilepsy has a different evidence base. There is no single best medicine for everyone.

SANAD II · focal epilepsy trial ↗ · SANAD II · generalised / unclassified epilepsy trial ↗ · Supporting source ↗

Ask whether the working definition of drug-resistant epilepsy applies and whether a specialist centre should reassess your options. Check whether previous medicines were appropriate, tolerated and adequately tried, and whether all current events are epileptic. Access barriers and difficulty taking treatment deserve help rather than blame.

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A ketogenic dietary therapy may help selected people, with stronger trial evidence in children than adults. It requires nutritional supervision and monitoring. Purified prescription cannabidiol has trial evidence in particular severe syndromes; that evidence does not establish benefit from every cannabis product or for every epilepsy. Ask about interactions, adverse effects and local approval.

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Check contraception interactions and discuss pregnancy plans before making treatment changes. Australian valproate advice includes established risks from exposure during pregnancy and a less certain possible paternal-exposure signal. Ask the prescriber what the current advice means for your situation. Do not stop treatment to manage these risks without an agreed alternative plan.

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The active ingredient, formulation, strength and other medicines all affect safe use. Use the current Australian CMI for patient instructions and PI for professional detail, checked with your pharmacist. The short Wise Choice summaries highlight selected issues and are not complete interaction, contraindication or dosing references.

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Use the individual clinical situation and, where appropriate, a pre-conception concentration as a reference. Agree monitoring, interpretation and dose-review responsibilities through pregnancy, with a written plan for the early postnatal period.

NICE NG217 · treatment and monitoring ↗

No. Explain the Australian TGA precautions and current product information. The paternal-risk signal is uncertain and should not be presented as proven causation or an Australian blanket exclusion of a demographic group.

TGA · paternal valproate precautions (2025) ↗

Product information has been updated with additional reproductive and neurodevelopmental-risk information. Use the current Australian PI and specialist counselling rather than relying on an older general safety summary.

TGA · Product Information updates, January 2025 ↗

Book a planning appointment rather than waiting for the first positive pregnancy test. Bring your seizure history, previous medicine trials, a complete medicine list and any questions about inherited conditions. A review can confirm the epilepsy diagnosis and discuss whether a treatment adjustment is worthwhile before conception.

• Ask who will coordinate your neurologist, GP and maternity care.
• Write down your conception plans and the next review date.
• If treatment changes, ask when it is appropriate to start trying.

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The aim is effective seizure protection with the most suitable reproductive safety profile for your epilepsy. Lamotrigine, levetiracetam or oxcarbazepine may be appropriate options for some people. Valproate carries important pregnancy and developmental risks; alternatives should be considered when clinically feasible. A medicine that works well for one epilepsy type may be unsuitable for another.

• Never stop, reduce or swap an antiseizure medicine yourself when pregnancy is suspected.
• Ask for a comparison using your seizure type, previous response and reproductive goals.
• A lower published risk does not mean that a medicine has no risk.

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Discuss a folic acid prescription before conception. Guidance differs on the best dose, so ask which dose and duration suit your medicines and local care pathway. The AAN guideline advises at least 0.4 mg daily before and during pregnancy, while recognising uncertainty about the optimal dose. Do not combine supplements without checking the total.

• Ask your pharmacist to check contraception interactions with every medicine.
• Use your agreed contraception until any treatment review is complete.
• Include vitamins, herbal products and non-prescription medicines in the review.

Supporting source ↗ · TGA · pregnancy precautions ↗ · Supporting source ↗ · Supporting source ↗

Contact your epilepsy team and maternity provider promptly and tell them the medicine names, doses and date of your last period. Continue the prescribed regimen while they arrange advice. If you cannot keep medicines down because of vomiting, seek same-day clinical advice rather than guessing whether to repeat a dose.

• Keep a dated list of medicines and seizures for the appointment.
• Ask whom to call out of hours and where to attend if seizures recur.
• Do not assume that an unexpected pregnancy means the baby will be harmed.

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Pregnancy can change how quickly the body clears some antiseizure medicines. Your team may compare blood levels with a pre-pregnancy baseline and review seizures and adverse effects. A dose increase can sometimes be needed even when you have not had a seizure; that decision belongs to the prescriber.

• Record blood-test dates, whether the dose was taken before the sample, and any agreed changes.
• Report changes in seizure pattern, falls or prolonged vomiting promptly.
• Keep routine maternity screening and epilepsy follow-up appointments.

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Lamotrigine is among the better-studied, lower-risk antiseizure medicines for pregnancy when it is appropriate for your epilepsy. It can usually be continued throughout pregnancy under specialist care. No medicine is entirely risk-free, and maintaining seizure control is important for both you and your baby.

Pregnancy often makes the body clear lamotrigine faster, so the blood level can fall even when the dose is unchanged. Ideally, have a baseline blood level before conception while seizures are well controlled, and record the dose and sampling time. If already pregnant without a baseline, contact your neurologist early to agree an individual reference level and monitoring plan.

Blood levels are commonly checked about every four weeks. Your neurologist may agree a four-to-six-week interval according to your results and how pregnancy is affecting you, with earlier checks when needed. Compare with your own effective baseline, alongside seizure control, side effects and missed doses; a laboratory reference range alone is not your personal target.

The dose may need to increase during pregnancy to maintain your usual effective level, even if you have had no seizures. Make every change in consultation with your neurologist, based on blood results and clinical response. Do not increase, reduce or stop lamotrigine yourself.

After delivery, lamotrigine levels can rise rapidly as clearance returns towards normal. If the dose was increased, agree a written reduction plan before birth: reductions usually begin in the first few days after delivery, aiming to return towards the pre-pregnancy dose over the following weeks as your neurologist advises. Arrange an early postnatal blood level, commonly within one to two weeks, and further checks as needed. Do not abruptly return to the old dose without the agreed plan.

• Use the downloadable Lamotrigine Monitoring During Pregnancy sheet to record the date, pregnancy week or days after birth, blood level with units, dose, and your clinician's instructions.
• For comparable results, follow your team's sampling instructions, usually before a dose; record when the last dose and blood sample were taken. Do not skip or delay medicine without instructions.
• Contact your treating team promptly for new marked dizziness, double vision, imbalance or vomiting after birth, or for worsening seizures at any stage. Do not wait for the next scheduled blood test.

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A convulsive seizure can endanger both the pregnant person and the pregnancy. Call 000 in Australia for a seizure during pregnancy; elsewhere use the local emergency number. A first seizure during pregnancy must not automatically be attributed to epilepsy because pregnancy-related causes need urgent assessment.

• Tell ambulance staff the gestation, seizure duration and any rescue medicine already given.
• Prepare a birth plan covering regular medicine, vomiting, sleep and seizure response.
• Discuss the delivery setting and pain relief with your maternity team; epilepsy alone does not determine the delivery method.

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Arrange help with night feeds and practical tasks before the baby arrives. If doses were raised during pregnancy, obtain a written postnatal adjustment and blood-test plan; levels may rise after delivery. New marked dizziness, double vision or imbalance needs prompt clinical review. Breastfeeding is often possible, with medicine-specific advice.

• Ask the baby’s clinician what feeding, alertness or weight concerns to watch for.
• Discuss contraception again; breastfeeding is not reliable contraception.
• Book the early postnatal epilepsy review before discharge.

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Make a practical plan that reflects your seizure pattern without assuming you cannot care for your baby. Feeding or changing at floor level can reduce the consequences of a fall. Arrange another adult for bathing and higher-risk tasks when awareness may be affected. Keep the baby’s own safe sleep space separate.

• Place the baby somewhere safe if a familiar warning occurs and call your helper.
• Keep essentials together so you do not need to carry the baby repeatedly on stairs.
• Write down who covers sleep, medicine collection and urgent transport.

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EURAP prospectively followed pregnancies exposed to antiseizure medicines. Its 2024 analysis of 9,840 pregnancies involving eight common monotherapies found different observed malformation rates, with levetiracetam, oxcarbazepine and lamotrigine lowest among the medicines compared. These were not randomised comparisons and do not capture every developmental outcome. Use the findings to discuss a suitable regimen before conception, not to change treatment yourself.

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If a partner takes valproate and you are planning conception, arrange a prescriber discussion. Australian advice identifies a possible paternal-exposure risk signal from observational data. Its uncertainty differs from the well-established risks of exposure during pregnancy. Ask about the current product advice and any recommended precautions.

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Confirm the working diagnosis, goals, medicine decisions, monitoring, safety advice, review date and contact route. Give the person an accessible summary and clarify which clinician will complete each action.

NICE NG217 · information and support ↗

Write your three main priorities before the appointment: understanding the diagnosis, improving control, managing a side effect or making a life decision. Mention urgent changes when booking so the clinic can triage appropriately.

Do not wait for a routine appointment for a seizure emergency or a serious medicine reaction.

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Describe what happens before, during and after each type of event, the age it began, frequency, injuries and recovery. Include the last event date and whether the pattern is changing.

If a witness can attend with consent, ask them to describe observations in their own words. A safely recorded video can be helpful, but filming must never delay first aid or compromise privacy.

Bring medicine names, formulations, doses and times from labels; record past medicines and why each stopped. Include supplements, contraception, allergies and other diagnoses.

Explain practical barriers such as supply, swallowing, cost, shift work or adverse effects. These are care problems to solve together. Do not change doses while preparing for the visit.

Ask what supports the diagnosis and whether there are alternatives. Clarify your seizure type or syndrome if known. Ask what the EEG, scan or other test can and cannot show, and how results will reach you.

If seizures continue, ask whether diagnosis, medicine suitability, adherence and further specialist assessment need review before another treatment is added.

Repeat the plan back in your own words. Ask for a written schedule if treatment changes. Confirm what to do after a missed dose, vomiting, an adverse effect or another seizure.

Clarify first aid, rescue treatment if prescribed, driving, pregnancy plans and any work or water precautions that apply to you. Ask who answers questions between appointments.

Before leaving, check test bookings, referral requirements, prescription supply and the date or trigger for review. Keep copies of letters and the current action plan together.

If you cannot follow the plan because of cost, availability or transport, contact the clinic rather than silently delaying treatment.

The ILAE definition concerns failure of two tolerated, appropriately chosen and used schedules to achieve sustained seizure freedom. Reassess diagnosis, classification and adequacy of treatment rather than simply counting prescriptions.

ILAE · drug-resistant epilepsy definition ↗

No. Specialist assessment clarifies the diagnosis and options. It may include event recording, imaging review and other assessments, and can identify surgical or non-surgical approaches suited to the individual.

ILAE · specialist and surgical evaluation ↗

Start with the person’s main question: confirming the diagnosis, controlling events, reducing adverse effects, pregnancy planning or participation in daily life. Record what would count as a useful outcome. A first visit and a stable follow-up need different agendas.

• Patient prompt: what is the one issue I most want addressed?
• Clinician prompt: what must be clarified or excluded today?
• Confirm preferred language, communication aids and consent for supporters.

Review the sequence, witness evidence and recovery rather than relying only on the word “seizure”. Distinguish new event types from established seizures. Ask about syncope, sleep-related events and functional seizures when relevant, recognising that more than one condition can coexist.

• Patient: bring the original witness account and safe recordings.
• Clinician: document evidence supporting the diagnosis and remaining uncertainty.

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An EEG should answer a clinical question and be interpreted alongside the history. A normal EEG does not exclude epilepsy, and an abnormal report should not replace clinical assessment. Review whether imaging, ECG or another investigation is relevant and whether previous results can be obtained before repeating tests.

• Patient: ask for the result and its plain-language meaning.
• Clinician: record how the finding changes the working diagnosis or plan.

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Document what each medicine was intended to treat, how benefit was assessed, adverse effects and why it was changed. Confirm the actual regimen and barriers to taking it. A medicine is not a treatment failure merely because its name appears in an old letter; adequacy and tolerability matter.

• Patient: bring packaging or the verified pharmacy list.
• Clinician: separate inefficacy, intolerance and incomplete trials.
• Agree the next outcome measure and follow-up point.

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Diagnostic uncertainty, continuing seizures, intolerable adverse effects or a need for specialised testing or treatment justify considering an epilepsy service. Referral is an opportunity to review the entire picture, not a commitment to surgery. The patient should understand the referral question and what happens while waiting.

• Patient: ask what the specialist assessment might change.
• Clinician: include event descriptions, treatment trials, test reports and the current safety plan.

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A review can be incomplete if it only counts seizures. Consider mood, cognition, sleep, reproductive plans, other conditions and day-to-day function. Invite the person to prioritise the matters that affect quality of life, and ask which other professionals should contribute.

• Patient: note effects on work, study, relationships and independence.
• Clinician: state who will follow up each non-seizure concern.

NICE NG217 · information and support ↗ · Supporting source ↗ · Supporting source ↗ · Supporting source ↗

Check that the person knows the usual first aid response, when to seek urgent help, and any specific rescue medicine instructions. Driving and high-risk activity advice should be individual and documented. Explain how to report a breakthrough event or side effect without waiting until the next routine appointment.

• Patient: repeat the key instructions back in your own words.
• Clinician: confirm written advice and who receives it with consent.

Epilepsy Action Australia · seizure first aid ↗ · Supporting source ↗ · Supporting source ↗ · Supporting source ↗ · Supporting source ↗

Write down the agreed diagnosis or uncertainty, current medicines, requested tests, who reviews results and the next appointment. A good plan also states what should trigger an earlier review. Give the person a chance to identify an instruction that is unclear or impractical before the consultation ends.

• Patient: ask for an accessible copy of the final plan.
• Clinician: name the owner and deadline for outstanding actions.
• Do not treat a pending test as reviewed until someone has communicated the result.

Separate focal, generalised and absence-epilepsy evidence. SANAD II was an open-label pragmatic comparison, and the childhood absence trial addressed a different syndrome and outcome. Efficacy is one part of selection alongside tolerability, interactions, comorbidity, reproductive safety and availability. Wise Choice highlights selected issues and does not replace current product information.

SANAD II · focal epilepsy trial ↗ · SANAD II · generalised / unclassified epilepsy trial ↗ · Supporting source ↗ · Supporting source ↗

Record indication, dose exposure, tolerability, duration and response for each schedule, as well as event classification and barriers to taking treatment. Consider comprehensive epilepsy-centre evaluation promptly when two appropriate schedules have failed. Explain that referral can improve diagnosis and identify several treatment options.

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Consider genetic testing where it can clarify diagnosis or management, with informed consent and counselling. Recognise that older adults require individual assessment of diagnostic alternatives, comorbidity, interactions, cognition and practical support. Suspected infantile spasms need an urgent paediatric pathway.

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Seek positive diagnostic assessment, including typical-event video-EEG where feasible, and assess co-occurring epilepsy and psychiatric conditions. Communicate respectfully and discuss indicated psychological therapies. Antiseizure medicines are not a direct treatment for functional seizures without another indication; any withdrawal belongs in the responsible clinician’s plan.

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