The Ministry of Health in Ontario should highly consider following the medical guidelines, and covering Keppra, also known as levetiracetam, for individuals on Ontario Drug Benefits (ODB), as a first line treatment. 

Currently, an individual with epilepsy who is on ODB, has to fail one anti-epileptic medications before being able to meet the criteria to have Keppra covered. 

People on ODB tend to be on Ontario Works (OW) or Ontario Disability Support Program (ODSP) for a reason - difficulty working due to medical reasons. People on OW or ODSP also tend to be those in the community with low literacy, low social determinants of health, language barriers, and difficulty attending appointments with neurologists and/or epileptologists.

These individuals should have Keppra (roughly $6 a week) covered as a first line treatment for the following reasons: 

1) Keppra covers both focal and generalized seizures. Thus, after being seen in the emergency room, a walk-in clinic, or their family doctor's office, it can be started right away, without needing to wait for an EEG (~$200), CT head (~$375), MRI head (~$600), or an appointment with a neurologist. When emergency room physicians see someone who had a seizure and consult neurology on call, they are very often recommended to start Keppra for this exact reason. 

2) Phenytoin (brand name Dilantin ~$2/week) is one of the other drugs that covers both focal and generalized seizures. That being said, it comes with many downsides. First, it is not safe in pregnancy and thus 50% of people being diagnosed with epilepsy should not be on it. If someone does get pregnant on phenytoin, the side effects to their child include: growth deficiency, developmental delay, cleft palate, heart defects, genitourinary abnormalities, as well as many more. All of those issues will also end up costing the Ministry of Health a lot more than just covering Keppra as a first line therapy. 

Phenytoin also needs regular blood work, sometimes as often as every 3 months. That blood work is also costing the Ministry of Health money (~$10.34 each time). People on OW or ODSP tend to also have many things going on in their lives that prevent them from going for routine blood work, making it hard to ensure that their epilepsy continues to be well controlled. If their epilepsy is not well controlled because it relies on routine blood work to be done, then they might actually have more visits to the emergency department than necessary (~$323 each visit).

Phenytoin also has side effects such as bone loss over use, which leads to the government needing to pay for Bone Mineral Density tests (~$152) every 3 - 5 years for these people. Once people on phenytoin have osteoporosis, then they need to be on medications such as bisphosphonates or Prolia ($968 per year), to deal with the osteoporosis. Vitamin D and calcium supplements are also highly recommended, but those are not covered by ODB.

3) Lamotrigine (brand name Lamictal, about $5/week) is safe in pregnancy and does not need regular blood tests. However, studies show that it has higher rates of severe cutaneous adverse reactions in people of Asian decent, thus ignoring 23% of the population of Ontario, while being only $1 a week less than Keppra. 

4) Topiramate (brand name Topamax, about $7.42/week - more than Keppra) can be helpful in both generalized and focal seizures. It is also not safe in pregnancy, accounting for 50% of the population of people with epilepsy. If someone on topiramate does get pregnant, then the side effects to their child include: behavioural and learning disabilities, intellectual disabilities, autistic spectrum disorder and problems with motor coordination. Again, all of those issues will also end up costing the Ministry of Health a lot more than just covering Keppra as a first line therapy. 

The lack of coverage of Keppra, a first line choice for treating epilepsy based on research, a very effective anti-seizure medication with low long term side effects while also being safe in pregnancy, leaves us medical professionals with poor options to control seizures in people living in Ontario. These poor options will actually lead to more costs to the Ministry of Health down the road. Thus, the below signed physicians, nurse practitioners, nurses, people living with epilepsy and those supporting people living with epilepsy are asking Ontario’s Ministry of Health to cover Keppra on ODB without needing to fail two antiepileptic medications first.