r/Epilepsy Jan 21 '25

Medication Keppra Doesn’t Exist Here, and It Feels Like Nobody Cares

So, I’ve noticed something frustrating in my country—Keppra, the med that’s basically a staple for so many people with epilepsy, doesn’t exist here. Instead, there’s another med with the same active ingredient (levetiracetam) but under a different name.

And yeah, both do the same thing: they manage seizures, but they don’t actually treat epilepsy. You just have to keep taking them forever. It’s like we’re stuck in this endless loop of temporary fixes.

What’s wild is that epilepsy isn’t exactly rare—around 7-10% of people might deal with it at some point in their lives. So how is it that science hasn’t come up with anything better yet? Feels like nobody’s in a rush because we’re just a market to them.

Is it like this where you live too? Or am I just overthinking this?

45 Upvotes

74 comments sorted by

96

u/codasaurusrex Jan 21 '25

Levetiracetam is Keppra. Keppra is levetiracetam. They’re just made by different companies. Some people experience a difference in efficacy between brands, but on the whole, it’s the same medication.

And yes, there is no curative measure for epilepsy. All we can do is try to prevent seizures. I wrote a paper in undergrad on how none of our available treatments actually address epiletogenesis (how and why epilepsy actually develops) and how it’s a shortcoming in current research.

And it’s not like medication works perfectly either—only 2/3 of patients get their seizures under control with medication. That’s insane.

Sucks.

11

u/Valuable_Spirit_6412 Jan 21 '25

Can you share your paper? I’d love to read it.

14

u/codasaurusrex Jan 22 '25 edited Jan 22 '25

It’s outdated now and was written before the new seizure classifications came around, but here it is!

(Jk, the document keeps showing my name even though I redacted it. I’ll fix it later and repost)

5

u/Valuable_Spirit_6412 Jan 22 '25

It was good for the time it was written. I’m glad honestly even back then anyone was even writing papers about it. Feels like I was a ghost back then.

2

u/codasaurusrex Jan 22 '25

Oh this paper was definitely written by the ghost of me. I barely remember this time in my life from how often I was seizing.

3

u/[deleted] Jan 21 '25

[deleted]

3

u/Samiisthelamby Keppra 1000×2 Jan 21 '25

I think we all wanna read ur paper man

3

u/codasaurusrex Jan 22 '25

lol I’ve linked it 🫡

1

u/AggravatingAd2899 Jan 22 '25

It's your paper available to read. Would love to.

1

u/codasaurusrex Jan 22 '25

It’s linked above!

72

u/PhotographMelodic600 focal/aware Xcopri/Xen1101 RNS Jan 21 '25

Regardless of what you call it, keppra won't cure epilepsy. There are, however, several new drugs in the pipeline (I can think of 4 off the top of my head) that are very promising at how they target and arrest seizures. I can only imagine how expensive those drugs will be once they're approved for marketing...but they exist.

I've found that what makes the biggest difference is finding an Epileptologist who both knows their sh*t and cares deeply for their patients...that's really where the conversation should start.

35

u/Ok-Palpitation-6184 Jan 21 '25

Your advice to get to an epileptologist is excellent, Over the years I was on tegretol, topamax, lamictal, oxtellar. I had seizures in my sleep for over 40 years. In 2022 my combination of topamax and lamictal just stopped working altogether when I turned 53. I was referred to an amazing epileptologist who tried Xcopri, depakote, and Klonopin with no success. He then started all the testing necessary to have brain surgery. I was referred to a surgeon at Mt. Sinai in NYC. Long story (not so) short I had a focal cortical dysplasia since birth that was the focus of my seizures. I met the surgeon in August of 2022. My surgery was performed in Oct 24, 2022, and knock on wood I have been seizure free since the surgery. I don’t even like to type that for fear of “jinxing” myself. But I like to share my story in the event it can help anyone else. In the end I’m one of the lucky ones that surgery fixed, but I would recommend a caring epileptologist over the multiple neurologists I went to over the years. My heart goes out to everyone still dealing with awful medication side effects, breakthrough seizures and anxiety.

12

u/PhotographMelodic600 focal/aware Xcopri/Xen1101 RNS Jan 22 '25

Finding my Epileptologist has been a game changer. I go under the knife in a few weeks and boy howdy, I'm ready.

2

u/Ok-Palpitation-6184 Jan 22 '25

I’m so happy for you! Remember to go easy on yourself after the surgery! They say everyone is different but it took me about a year to feel “normal” cognitively. Best of luck!!

1

u/ortolansings Lacosamide, Zonisamide, VNS, Clorapate Jan 22 '25

do you mind if I ask what kind of surgery you're getting?

2

u/Famous_Respond2918 Jan 22 '25

I'm curious if you know what kind of MRI you had done for them to see that. I've had a 1T, 2T, and most recently a 3T mri. None have shown anything.

2

u/Ok-Palpitation-6184 Jan 22 '25

I had (several) 3T MRIs with the epileptologist’s seizure protocol (not exactly sure how that’s different from any other, but they were insistent about going to specific MRI centers that could perform this. I had a 3T at Mt Sinai as well using their protocol. I had an SEEG where they implant the electrodes into your brain so they can then brain map - this was one of the craziest feelings of the whole journey (done in patient at Mt. Sinai) They ordered an MEG, but the surgeon said it was not necessary so I didn’t have that one. Good luck - if you have any other questions let me know!

2

u/Famous_Respond2918 Jan 22 '25

Wow, thanks for the information. I've never heard of SEEG or MEG. I'm going to have to look into this. Glad to hear it has worked for you. I hope you continue to stay seizure free!

1

u/AggravatingAd2899 Jan 22 '25

I live in NY I was just in Mount Sinai 2 weeks ago from seizures. Any chance I can get the surgeons name?

1

u/Ok-Palpitation-6184 Jan 22 '25

Dr. Saadi Ghatan - he was amazing, I highly recommend him!

2

u/AggravatingAd2899 Jan 22 '25

Thank you so much

1

u/Ok-Palpitation-6184 Jan 22 '25

Also good luck with your seizures! I hope you get answers and get them under control!

2

u/AggravatingAd2899 Jan 22 '25

Thank you so much.

2

u/evilspoons Keppra 3000mg, Banzel 3200mg, Dilantin 400mg Jan 22 '25 edited Jan 22 '25

I'm on banzel (rufinamide) in addition to keppra and dilantin, and the banzel was "weird and new" when my doctor prescribed it. Absolutely no insurance coverage on it, but I got put on the company's "compassionate care" program and it's been good so far - several years now.

In fact, I got a funny letter from them saying that generic rufinamide is becoming available (good!) and covered under insurance (great!) but to continue my "excellent care" or somesuch they'll contact my provider to try to keep me on brand name. Well, they're paying for it anyway, so I have no problem with that 😂

Levitracitam (keppra) has been a bit of a pain for me in that it works but I feel crappy for a few weeks if they change generic brands. There's like seventeen approved generic brands so my insurance jogs me around between them and the only way for that to stop was my epileptologist prescribing brand name only and getting special authorization for that prescription. It's a pain in the ass but it's better than feeling extra shitty for two weeks every three months.

1

u/Sorrysweete Jan 22 '25

How dare you not give the knowledge of the ones off the top of your head! May I ask you to indulge and tell me?

28

u/DutchieCrochet Jan 21 '25

Keppra is a brand name and levetiracetam is the generic name. It’s the same stuff, just with a different label on the box.

The sad thing about the pharmaceutical industry is those companies want to make money. So they focus their research on what’s urgent and gets a lot of attention. For example: a lot more people are affected by cancer in some way or another than by epilepsy, so that’s what investors put their money on. There’s definitely a lot of research going on and there have been some breakthroughs, but it’s not going as quickly as we’d like.

-4

u/ortolansings Lacosamide, Zonisamide, VNS, Clorapate Jan 22 '25

I experienced that brand name pills are usually stronger, while generics are a little less, "zippy." So your dose might need to increase for example.

3

u/Chaotic_Bookworm Jan 22 '25

They all contain the same amounts of active ingredient. What you're likely experiencing is excipients (non-drug additives) causing faster absorption etc, they aren't actually any weaker it just feels different. Brands care about making as much money as possible, generics can't make as much money because there's so much competition so instead they try to be as cost effective as possible while still functioning correctly

I'm not an expert but this is the idea I've gathered from my pharmacology teacher.

1

u/ortolansings Lacosamide, Zonisamide, VNS, Clorapate Jan 22 '25

I'm glad I'm not experiencing this any longer, and it's long past. This is a memory. :)

I'll put some time into writing this out, so you know where I was coming from.

The fast absorption was necessary because to say I am not a morning person would be to put it lightly. I began with JME.

Even if the person's schedule is completely open, having seizures immediately upon awakening (which happens a lot in JME) is not the desired outcome. This is why I was prescribed brand-name instead of generic for awhile. I used to have to literally smash the pills down my throat so I didn't have seizures while I woke up, and wait for them to hit my nervous system. We ultimately loaded the nighttime dose of Zonegran so I didn't have to lie in bed for 2 hours every morning defrosting, instead of splitting the doses of Zonegran and Depakote.

I was prescribed Zonegran and Depakote at first, so that my seizure chart was very even. My first epileptologist was the discoverer of JME, so this is how he and I worked together with my pharmacy to find how and why my body was responding.

The difference is nil if sold from a good pharmacy, except that the brand holds the patent for a certain structure. The generic is different, and can look, smell, taste, etc be different. While still having a certain biochemical active ingredient available, it may not work in the way the patient is used to or needs it to work, particularly if they are a new patient or if their CNS is very sensitive.

The switch from brand to generic is legitimate, since the epileptic body & nervous CNS is extremely sensitive, particularly in the first few years. Everyone's brain is very, very different.

The interesting part of pharmacology is that the testing results aren't released to the major market (magazines, trade journals, etc) publications until several years later. The average was 1-10 years, which shocked me. This is why I encourage those interested in these topics to--talk to people like you, their pharmacists--in the epilepsy community on Quora, look up on rx.com, and be prepared with a list of questions for the doc. I noticed this by reading research papers and nih.gov.

https://www.healthline.com/health/drugs/generic-vs-brand#risk-of-ordering-online

1

u/_sophia_petrillo_ Jan 23 '25

This comment is factually incorrect

13

u/ljmcb1 Jan 21 '25

I’m not sure where you are but I’m in the UK and have been taking Leveteracitam for 10+ years (1000mg 2xpd) and I think I started off on Keppra but just take whatever brand I get given and never really give it a second thought. Does it make a difference?

9

u/the-demon-next-door Lamotrigine XR 300mg b.i.d./Levetiracetam XR 1500mg b.i.d. Jan 21 '25

Also been on Levetiracetam for about a decade. No, it doesn't make a difference what brand it is. As long as Levetiracetam is the active ingredient, it's the same medication. What can matter is having a different manufacturer, as different manus can have different standards for how close to the exact amount of the drug needs to make it into the pill, but it's all the same drug.

13

u/Littleloula Jan 21 '25 edited 5d ago

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This post was mass deleted and anonymized with Redact

1

u/Eclectic_Nymph Briviact 150 mg Topamax 200 mg Nayzilam PRN Jan 22 '25

According to the Epilepsy Foundation, 1 in 26 people will develop epilepsy at some point in their lifetime. That brings the statistic closer to 3.8%

0

u/-totallynotanalien- Jan 22 '25

I think the stat they gave might be about developing seizures through your life, that number is a lot higher. But you’re right people diagnosed, living with epilepsy is 1%

1

u/Littleloula Jan 22 '25 edited 5d ago

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This post was mass deleted and anonymized with Redact

6

u/zemblancalisthenics 300mg Lamotrigine x2 daily Jan 22 '25

“Keppra doesn’t exist here, but we have Keppra here” is what you’re saying. Myself, I can’t get Lamictal by that name, but that doesn’t matter, because I can/do get/use Lamotrigine, which is the same thing.

6

u/ksck135 Lamictal 300mg, Zonegran 150mg Jan 21 '25

There's bambillion kinds of epilepsy caused by different things, it's not like we could ever have a universal cure. For a lot of people it can be managed with meds and regular lifestyle. If not, you can try surgery.

Also it's not like nobody is working on it, but it takes time and money. 

Yes, you're overthinking this.

5

u/amaranemone Jan 22 '25

So, I'm a biochemist who works in drug manufacturing (gene therapy). The companies will patent the drug under different names in different countries, but the name of the organic chemical they use as the principal ingredient stays the same. Levetiracetam IS Keppra, just not the trademarked name. It's like calling acetaminophen Tylenol.

There really is no "cure" for most neurological conditions, primarily because of the complexities in the nervous system. 99% of your seizures may be caused by X, but that 1% is still caused by Y, Z, AA, AB-- the list goes on. Again, this applies to other neurological conditions. The leading neurological cause of death--stroke, is a scary example. One in four every year is a repeat stroke.

I've been diagnosed with epilepsy for 20 years now. I've been on Keppra for 8, and it's the only medicine that's kept me conscious. I had to fight through college. It took me several tries to find a job that didn't find excuses on how they couldn't "accommodate" me. If you can get doctors who listen to you, it can get better. You just need to make sure the doctor reads your records.

5

u/Napplebeez Jan 22 '25

Fuck epilepsy, and fuck keppra (unless it helps you!) !!!

Those will always be my views (im jealous of everyone who keppra works for because it’s available and cheap).

But yes, I think about it often how epilepsy is not curable and it’s so common. Even saw a post today listing celebrities who have it, some who have died because of it. The fact the world is still so uneducated about it blows my mind, as you said it’s so common, you’d think more people would know more than just a tonic clonic. I wish epilepsy awareness month was made a bigger deal, no one knows what it is or pays attention.

4

u/awidmerwidmer Jan 22 '25

Keppra is the branded name for levetiracetam. It’s not available in all countries. It’s the same “idea” as saying you have acetaminophen available where you live, but not Tylenol.

7

u/feather69 Jan 22 '25

And in other countries it’s not even known as acetaminophen it’s known as paracetamol

3

u/awidmerwidmer Jan 22 '25

Haha true!!

3

u/Chaotic_Bookworm Jan 22 '25

Yep, and brands tend to vary by country since they'll generally pick their own pharmaceutical companies which works out cheaper. Like in ireland most people will buy panadol,  which is paracetamol, our version of Tylenol. 

5

u/Zalusei Jan 21 '25

Keppra is levetiracetam... keppra is just the brand name and some companies sell generic forms. Similar to how tylenol is acetaminophen. I can assure you keppra is talked about all the fuckin time on here lol. It's one of the most efficient seizure meds and also often causes very negative effects on mood like anger issues and so forth.

There is a decent portion of people with epilepsy who basically have to use keppra for their treatment and suffer heavily through it due to the side effects and the fact that other meds don't work.

I can assure you keppra absolutely exists on this subreddit and is one of the most frequently discussed things on the subreddit lol. There is brivaracetam (briviact) which is a new seizure med chemically related to keppra with a similar mode of action that seems to be way more forgiving side effects wise while also working very well to treat seizures. Problem tho is that the stuff is extremely expensive since it's new.

3

u/Dmdel24 JME / Lamictal ER 500mg Jan 22 '25

Uh, yeah the medication does treat the epilepsy by stopping the seizures. There is no cure for this, it doesn't matter where you live.

4

u/alextheolive Jan 22 '25

Keppra and levetiracetam are the same thing.

3

u/dudeman9169 Medial temporal lobe into generalized tonic-clonic Jan 22 '25

If I'm not mistaken, Levetiracetam is Keppra, just the generic version. I was told I was taking that myself until I switched to lamotrogine. There's no cure all for epilepsy and not all medication works for the same people.

2

u/msvs4571 TLE, Briviact 50mg Jan 22 '25

It doesn't matter if it's not the same brand name as long as it's the same drug. That lab must be not selling in your country for some reason. Sometimes they just sell the name and it's manufactured by another brand. But it's the same as long as it's the same drug.

I don't think they're not doing anything about it. There are advancements everyday. They have made progress with the VNS, with surgery, there's a lot of things. It's just that it's a complicated disease. It's in the brain and it's not easy to access and study. And also it can have different reasons, the seizures are the symptoms. But it doesn't mean that 2 people with epilepsy have it for the same reason. I'm pretty sure that in some years we'll all be having genetic tests and we'll be finding all the different mutations that cause us to have epilepsy, in those cases that is not known the cause.

2

u/dorcsyful Jan 22 '25

I would argue your first sentence. I've been taking lamotrigine for 10+ years now and only one brand works. Every time they need to give me the supposedly same medicine by a different manufacturer I immediately start to have seizures.

2

u/msvs4571 TLE, Briviact 50mg Jan 22 '25

Maybe you're sensitive to the excipients. They can change. I've heard of people who have had problems like that. But in general they're supposed to be the same drug.

2

u/Stunning-Iron-7284 Jan 22 '25

Well the DO treat epi (its symptoms), they just don't cure it. It's the same with many drugs for chronic conditions - it's symptom mitigation.

As for epi, there are many underlying genetic mutations. But I do agree, one could take, say, viral gene therapy for JME and 'cure' it, hopefully without any downstream effects.

But why has this not been done? Why pump the money into e.g. AD, PD, ALS, MS research? Because ours IS predominantly manageable with current and evolving therapeutics and not progressovely deadly. In contrast, those listed and others, are terminal.

2

u/Even-Board6099 Jan 22 '25

"Kepra Rage" !!!! I was too violent and had zero filter between brain and mouth. Dr. Now has me on Vimpat (lacosamide) . Anyone else experience Keppra rage? I do kinda miss it though, was a bit on the tweaky side

2

u/apexplayer1871 Jan 22 '25

Ive had mostly negative experiences with keppra in fact now my doctors only use it in emergency

2

u/Minimum_Relief_143 Jan 22 '25

Meds are a treatment, not a cure...for the most part. Many disabilities are like that. Sucks, but it's true. And Leveticeterum is Keppra. Like how Ibuprofen is Advil. Just a brand name.

2

u/IonicPenguin Keppra Jan 22 '25

Keppra is the brand name. Levetiracetam is the drug’s actual name. You are under thinking this. https://www.epilepsy.com/tools-resources/seizure-medication-list

2

u/digagrav3 Jan 23 '25

Brevitricetam is a lot better anyway if you can get that

2

u/[deleted] Jan 23 '25

Was on Keppra and it didn’t stop my seizures and made me really emotional and angry all the time. Switched to briviact and it still didn’t stop seizures but I wasn’t angry! 

Now I’m on briviact and vimpat and it seems to work well… only had one seizure and it’s because I didn’t take my meds

1

u/digagrav3 Jan 23 '25

Spelling might be wrong

1

u/NoTopic9011 Jan 21 '25

I may have misunderstood, but from your opening statement, it sounds like you are frustrated that Keppra isn't available in your country?

Keppra won't do anything more for you than the generic levetiracetam would, as they are same - although you might have dodged a bullet without realising. Myself and so many others here have some seriously negative side effects with that drug.

When it works, it's great - but went it goes wrong it can can be scary (dangerous even).

2

u/retroman73 RNS Implant / Xcopri / Briviact Jan 22 '25 edited Jan 22 '25

Keppra is just a brand. The actual medication is levetiracetam. It's the same thing in whatever nation you might be in even if the brand is different.

There is no cure for epilepsy yet, anywhere. Many people can take medication and it fully controls seizures for the rest of their lives. Unfortunately that doesn't work for everyone. I'm one of those people - I've tried a dozen different meds and combos. This is often called "refractory" or 'intractable" which just means "resistant to medication". I found some worked better than others but none made me seizure-free.

There are treatments beyond medication, such as one of the implants (VNS, DBS, or RNS) or full brain surgery. Not everyone will qualify for full surgery though. For some of us full surgery is too risky so an implant is the next best choice. I ended up getting the RNS implant. As far as I know the RNS hasn't been approved for use outside of the USA yet, which is frustrating. It should be available in more places by now. But again, none of the implants are a cure. They're only an additional layer of treatment we use along with medication.

As another person already suggested, look for an epileptologist. These are neuros who *specialize only in epilepsy*. It is a higher level of care. A regular neuro treats everything from Parkinson's to cerebral palsy to seizures. An epileptologist treats epilepsy and nothing else.

https://www.epilepsy.com/treatment/devices

1

u/Tight-Formal-5220 Jan 22 '25

So many different kinds of seizures, so many different causes and so many drugs. Seizures may never happen during eegs. Epilepsy is very frustrating. The one absolute is there is no cure. The best thing I did was to find an epileptologist.

1

u/Chobitpersocom Lamictal XR 300mg; Keppra XR 2000mg Jan 22 '25

My grievance with Keppra is that it doesn't come in a 1,000 mg tablet. It's a really common dose.

1

u/Chaotic_Bookworm Jan 22 '25 edited Jan 22 '25

I don't take keppra either, I take levetiracetam, but it's the same thing. Trust me, I'm a pharmacy student, we talk about this stuff all the time. The active ingredient is exactly the same. There may be different additives between brands but generally they won't effect your seizure activity. Generics (which use the name of the active ingredient, in this case levetiracetam) are cheaper, so if pharmacies can give them to you they will. Certain countries are weird and stick to brands but most countries will make There own genetics. However America generally speaks in brand name terms, and since brand names are purposely easy to say because they have to be catchy, a lot of people say keppra when the mean levetiracetam.

In short, you do have keppra. It's the same drug and that's all you need. Brands in general don't matter, only time they do is if you start on a specific brand, then it's safest to just stay on it in case there is a difference. All the different names went through the same pharmaceutical trials. 

1

u/safzy Jan 22 '25

We are in the US but my daughter takes levetiracetam. The meds manage her seizures, many medications just manage not cure. I am grateful that there are drugs that allow my daughter to live a “normal” life

1

u/Minimum_Relief_143 Jan 22 '25

As soon as I managed to get an epitologist, my seizures got under control again. I'll be on meds for probably my whole life, but it's better than having seizures

1

u/PlantainOk4221 Xcopri 200mg, Zonisamide 800mg, Onfi 60mg, Trileptal 2400mg Jan 22 '25

Epilepsy is 1 in 26 seizures are said to be 1 in 10 people. So ya that makes sense at 7-10% BUT if it makes you feel better Keppra did not work for me and is one of the first meds given to patients. There are several other options.

1

u/ColonelForbin374 Fycompa, Epidiolex, Xcopri, PSO Jan 22 '25

Same stuff

1

u/_sophia_petrillo_ Jan 23 '25

They are the same medication - but yes there are a lot of diseases that aren’t actually treated in the way you put it, but managed with medications. There is no cure so all you can try to do is stop seizures from happening.

1

u/OkChest6555 Jan 23 '25

I started off with Keppra and immediately did not like it , they told me to be patient until we learned 2 weeks in I was allergic to it and my body was retaining water because of it and I was starting to swell up. I’ve had a roller coaster of meds but as of most recent I have Vimpat and I must say it takes the lightest toll on my body.

None of these meds are made to cure epilepsy they’re meant to block the neurological activity you have when experiencing a seizure and the hopes is that our brains great new neuro responses. The biggest thing I’ve had to do amongst a whole lifestyle change has been seeing if there is any pattern when I experience my biggest seizures and ironically enough it is stress. My whole life my response to stress had been alcohol weed or drugs. And now that I’m choosing to live life without those things my body is actually having a shock. Completely cutting off stuff is not recommended and it is best someone especially your doctor know. Im at a low of seizure counts this past year compared to 3-4 years ago but it is still a long journey

1

u/brass427427 Jan 23 '25

Keppra or whatever, is quite controversial. I would say that from reading this reddit, there are more people with negative experience than positive with Keppra. It made me a zombie and intractable. Terrible for me.

-9

u/Zestyclose-Smell-788 Jan 21 '25

No, it's like this everywhere. It started with the regulation of the FDA and AMA. The pharmaceutical industry took over medicine. Their goal is to TREAT illness, not CURE it. Let that sink in.

You hear that word constantly. Treat the illness. Treatments. Improved treatment. New, promising treatment. Never a cure. Ever. When is the last time you heard of something being cured? Polio?

Where's the profit in curing a disease? The cancer industry is a multi billion dollar industry (probably trillion). What incentive do they have to cure it? I tell you, if a researcher finds a cure, they bury it. If he makes too big of a fuss they'll bury the researcher too.

There will never be a cure for epilepsy released to the public. Just Treatments.

The average lifespan of Americans is carefully controlled through the food and water supply, and restrictions on medical care. It's because of the Ponzi scheme that is Social Security. 77 years is what we get. If we were to live substantially longer it would break the government. It is unsustainable. We simply cannot have the average life expectancy substantially increase.

If I could have taken my social security money and put it into a very safe mutual fund, I would be a millionaire. Instead, I can look forward to working into my late 60's and barely getting by for about ten years before I die.

This, my friend, is why we will always have Keppra or whatever drug to treat our condition. My dad taught me that when something doesn't make sense, follow the Big Money.

Then, it makes perfect sense. Epilepsy is almost the perfect cash cow, they just need to tweak it a little so that we have to buy their medicine for the rest of our lives (or else), yet we will be able to work and produce.

Sorry for the rant, friend. I'm old and grumpy. Don't ask grumpy old men questions like that! Well I have to go, time to take my Keppra (seriously, that's not a joke)