PARTICIPANTS William Rosenfeld, MD Director, Comprehensive Epilepsy Care Center for Children and Adults, PC, St. Luke's Hospital Blanca Vazquez, MD Director, Clinical Trials Epilepsy Program, New York University Medical Center Justine Flotteron Living with Epilepsy EDITORIAL CONSULTANT Susan T. Herman, MD University Hospital of Brooklyn Epilepsy Center

ANNOUNCER: Justine Flotteron is one of over two million Americans with epilepsy, a neurologic condition that makes people susceptible to seizures.

BLANCA VAZQUEZ, MD: The social impact of epilepsy is such as in families in the old days no one talked about it. Socially it can affect your relationship with your peers. It can affect your relationship with your significant other. Epilepsy does have a lot of negative connotations

JUSTINE FLOTTERON: I refused to even believe that I had it even once I was diagnosed with it. I didn't take medication for years. I refused to.

ANNOUNCER: Justine suffers from a type of epilepsy known as partial seizure. Without treatment, Justine continually had seizures.

JUSTINE FLOTTERON: I used to sit at my desk and I'd fall on the ground. A minute later, get back up, sit back down in my seat. Nothing was disturbed or anything. It was like kids were used to it. I was used to it.

ANNOUNCER: Then something happened when she was in the hospital for an unrelated surgery.

JUSTINE FLOTTERON: At this time I was probably 17. It was after a major surgery when I was coming out of the anesthesia, I had a grand mal seizure. That's actually when I first started taking medication.

BLANCA VAZQUEZ, MD: We aim for a patient complete control of seizures and minimizing side effects for that patient.

ANNOUNCER: Initially Justine started on a combination of drugs which were partially effective, but the medications' side effects were creating even more problems for Justine.

JUSTINE FLOTTERON: I was having double vision constantly, which really is just terrible, and it gets you nauseous. You lose your equilibrium.

ANNOUNCER: Dr. Blanca Vasquez, Justine's physician, tried to be her patient's advocate.

JUSTINE FLOTTERON: She was like, "We need to get you off these medicines. There are other things out there. There are newer drugs out there that can be doing better for you

ANNOUNCER: Eventually Justine tried a newer class of drugs, providing better seizure control with a single medication.

JUSTINE FLOTTERON: Honestly I know to this day things are a lot better. I mean, yes, I still have my normal one or two seizures. But to me one or two a month is nothing. I used to have three to five a day when I was younger.

ANNOUNCER: The side effects on the new drugs are so small to even none. Taking just one kind of drug has finally simplified the delicate balance between effectiveness and side effects.

WILLIAM ROSENFELD, MD: We always try for monotherapy. The reason we try for monotherapy is that one drug usually will give you less side effects than two drugs.

Now, clearly there are, even in monotherapy, drugs that do have more side effects, but when you add more than one drug together, you clearly end up with a higher number of medication side effects.

ANNOUNCER: Convenience is also a plus, and Justine now takes only one medication twice a day.

WILLIAM ROSENFELD, MD: Many of the new drugs are better in terms of twice a day dosing, and that makes it much better for patients in terms of compliance.

ANNOUNCER: Deciding which therapy is right for each patient is determined by several factors.

BLANCA VAZQUEZ, MD: The selection of antiepileptic drugs is always based on what seizure type the patient has. The newer generations of drugs are approved for partial epilepsy. In monotherapy, we have two. Lamotrigine is conversion to monotherapy from another agent, and Trileptal is initiate new patients that have just been diagnosed with epilepsy.

ANNOUNCER: Another issue for women to consider when making medication choices is the subject of birth control and pregnancy.

BLANCA VAZQUEZ, MD: Contraception is very important to consider when you're selecting the antiepileptic drugs because some of the drugs may lower the efficacy of the oral contraceptive and they will have a failure rate of about six percent.

WILLIAM ROSENFELD, MD: So the patient has to use other means of protection, condom, condom and foam, and at least the higher dose birth control pill.

ANNOUNCER: Today, monotherapy is beneficial for women wanting to have children

BLANCA VAZQUEZ, MD: A patient that can be maintaining one drug will be more likely to have less incidence of side effects for their baby than a patient who has the combined medicines. We try to always go to monotherapy before the patient gets pregnant.

ANNOUNCER: Using a single newer medication for her epilepsy has helped Justine Flotteron create a full life. Her epilepsy is now what she always wanted it to be: a non-issue.

JUSTINE FLOTTERON: Outside of work life, on weekends I go snowboarding. In the summer I go boating or hiking. Some people might think like, you know, you have epilepsy, you're not allowed to do these things. Don't let anyone ever tell you can't do anything because you can do whatever you set your mind to do. Honestly, it's your life.