To Treat or Not to Treat: Ethical Deliberation on Epilepsy Treatment

Abstract

Patients who have experienced two unprovoked seizures are diagnosed with epilepsy and are frequently prescribed anti-epileptic drugs (AEDs). However, many of these patients will be subject to only mild and infrequent seizures and thus every patient must be carefully evaluated on an individual basis to determine the anticipated cost vs. benefit of AED treatment. Not everyone who has had two unprovoked seizures should necessarily be prescribed AEDs, as there are many factors to consider before initiating AED treatment. AEDs have substantial adverse physical, cognitive, and psychosocial effects, and must be carefully chosen for each patient based on the patient's specific needs and circumstances. This article seeks to summarize current research and literature on AEDs, positing that the patient's knowledge of and preference for treatment must be considered, along with reasonable compliance concerns, such as history, pocketbook issues and side effects. In choosing to begin AED treatment, patients must be fully informed of all side effects, including potential effects on career and quality of life from the various side effects, as well as the financial impact of paying for AEDs on a routine basis. In sum, we attempt to remind physicians of their broader scope of care and provide a set of questions for determining the appropriateness of AED treatment.