Parents have learned that MAE is an extremely unpredictable disorder to treat – there really is no right answer for the anti-epileptic medication (AED). The dosage, titration schedule, and whether it works or has severe side effects is also highly variable for each child.
MAE can be difficult to treat because it doesn't always respond to medications. However, newer medications released over the past decade – including Felbatol, Zonegran, Keppra – are proving to be highly effective for MAE which is one of the reasons that long-term outcomes for our children have improved. See medications recommended for MAE.
One drug, or perhaps two or more
Treating specialists will try to achieve seizure control with one medication (monotherapy). It may involve trialling several types of medication. If the epilepsy fails to respond to monotherapy, a second or even third medication may be introduced (polytherapy) to achieve control.
Some children are fortunate to find seizure freedom with the first medication they try. For some it may take patience, perseverance, trial and error before they find a medication that works. Or may involve using more than one medication (polytherapy)
Drug sensitivity and paradoxical seizures
In MAE, it is not uncommon for some children to find that medications – whether used as monotherapy or polytherapy – actually increase the severity or frequency of seizures (which means that they cause paradoxical seizures or a worsening of the condition). Parents have seen that even medications which are specifically recommended for MAE can cause this paradoxical reaction. For one child, the standard therapeutic level of an AED may be the answer, but for another child the same levels might lead to toxicity.
Perhaps this reaction is common in MAE and similar disorders involving multiple seizure types because what works for one seizure type (say, absence) may lead to the worsening or even the emergence of another seizure type (say, tonic-clonic). What we have learned from parents in our webring is that this susceptibility to paradoxical seizures is not uncommon.