Depakote, or valproic acid, is the worst: I sit on the couch with my brother early Saturday morning and take my prescribed dose.

He says there’s no way it’s that bad. It is, I say, it really is. We wait half an hour, and then, with geyser-like regularity, I vomit.

John is suitably impressed. We go to the neurologist, and I get a new medicine.

Dilantin, or phenytoin, is alright. It doesn’t control the seizures well. It also strips the enamel off my teeth.

I get a new medicine.

Lamictal, or lamotrigine, is the one I hang in there with. It’s the one I make excuses for. Some of the quirks I get used to: it makes my mouth numb for a while after I swallow it, and it loosens my coordination to a toddler-like coltishness, but I persevere. Look at the chicks in rom-coms, klutzy girls are hot. This is the kind of thing I tell myself when I drop all my things on the stairs of the commuter rail platform with twenty-odd rushed and frosty Bostonians directly behind me.

But the seizures get worse over time, and my neurologist increases my dose. The headaches, which were omnipresent but dully tolerable, become too obtrusive to bear. I squint all the time, and sleep sixteen hours some days. Finally, I break down: I quit taking it altogether; I become discouraged.

In February, I have a grand mal seizure in a grocery store halfway down the health food aisle. When I wake up in Newton-Wellesley hospital, I wonder if anybody saw up my skirt. I hope they didn’t take pictures. People do shitty things like that, in college towns. Probably they don’t mean any harm, but it’s something they do.

I joke about this with the ER doctor to put off the conversation about why I am not taking any medication to control my seizures. When I finally confess, he is very stern with me.

I get a new medicine. Keppra, or levetiracetam, works better than I’ve learned to expect. My seizures stop, my coordination is fine, I can dance again. I’m tying on my pointe shoes when I notice a strange cluster of reddish welts on my palms. Willfully, in the interest of hope, I ignore it. By the end of the week the rash has spread to my knees, elbows, and feet. I can’t wear my pointe shoes anymore; I wear flip-flops and shorts to my neurologist’s office, and before he makes an impression on his low rolling stool, I get a new medicine.

Topamax, or topirimate, makes soda taste weird. At first, I’m very excited by this: maybe I’ll kick my diet coke habit. I come close, too. I’m chugging water and doing alright on the seizure front when, in mid-May, during the northward migration of Monarch butterflies, I develop kidney stones. There must be fifty of them shimmering outside my bathroom window, and their shadows flutter even though my closed eyelids as the most exquisite pain subsides to the realization that it’s time, yet again, to get a new medicine.

Vimpat, lacosamide, is bad news all around: poor seizure control, and intense headaches. I quit after the initial titration and call my neurologist asking for something better. I already know it’s a long shot.

These days, it’s Zonegran, zonisamide, which has a side effect profile not unlike Topamax. I’m suspicious, but I’m also hopeful. There are things I want to do in life, and it’s hard to do them with uncontrolled seizures. The key, I’ve come to understand, is not to expect of medications what they were never designed to deliver: there’s no cure for myoclonic epilepsy; that’s reality. The goal is to take a medication with side effects more tolerable than seizures.

* * *

This isn’t an unusual experience. ‘Cycling’ through epilepsy medications is more or less the shape of things for people with epilepsy, especially the permanent sort. There’s little time for playing around: the afternoon I receive my new prescription, I go to the pharmacy to fill it.

At the pharmacy, the clerk asks me if I’m aware how much my prescription costs. Her mouth remains open a little as she looks up at me wide-eyed.

I am aware.  A 90 day supply of the anti-seizure medication that makes it possible for me to live with epilepsy costs $380. That’s after my insurance covers a significant portion of the price. I’ll pay over $1,500 for my medication this year. If I didn’t have insurance, I’d be paying nearly double that. On the forums people with epilepsy use to talk shop about mouth guards and ugly medical ID bracelets, one can always find a post or two mentioning interest in donations of unused medication. We all know this isn’t a good idea, but the cost is why.

The cost is why, and for more reasons than you might immediately expect. Epilepsy is the sort of condition that can inspire particularly brutal anxiety; ‘boo’ moments are in its nature. (One moment you’re pouring a cup of coffee, and the next moment you’re struggling to splash cold tap water over second-degree burns. When it comes time to hold your infant nephew, you hesitate, and for good reason: you just never know.) But for poor people who live with epilepsy, the psychological burdens of the condition are markedly intensified compared to their wealthier counterparts. When costs are high and options extremely limited, even the most risky businesses — say, the sharing of highly potent prescription drugs with strangers — are superior to the alternatives.

And what of the alternatives, the better ones? There is always the option of resignation, which usually precludes driving, and can severely impact work. The great untreated epileptics of our imagination — Julius Caesar, Fyodor Dostoevsky — are rarely the sort with rigidly demanding work schedules. On the contrary, even epileptics themselves tend to imagine untreated epilepsy as a thing of art and passion, the sort of condition that gives itself more readily to contemplation and otherworldliness in the style of Dostoevsky’s Prince Myshkin  than to the necessary, ordinary work of everyday people. For poor people with epilepsy, the most appealing option is clearly treatment. But even when treated, poor people suffer far more debilitating side effects from seizure medications than wealthier patients, and spend more time in the doctor’s office to boot.

It’s hard to say exactly why. The simplest answer is, paradoxically, the most complex: poverty intensifies the harm of epilepsy. Consider the illicit sharing of prescription medication, for example, due to cost: we now know for certain that poverty strains cognitive skills to the point of exhaustion, compromising decision-making capabilities. A wealthier person may be annoyed or even burdened by the cost of seizure medications, but for a person living in poverty, the decision to pursue medication illicitly — or to undertake any number of right-minded but ill-conceived avenues to handling life, say, driving unlicensed and untreated to work, or self-medicating with poorly suited but passable street drugs — may appeal unduly for reasons totally unrelated to moral or personal failures.

A noble solution would include the extension of full-coverage healthcare benefits to the poor, the sort that would ensure their access to consultation and medication at whatever dose necessary. And that would be an excellent response, but it wouldn’t produce equality between the rich and poor in terms of epilepsy. The falling sickness, it seems, does not fall evenly: poor people develop epilepsy at greater rates than wealthy people do. Better access to healthcare could lessen some of the factors that shape that reality, but not all, and not completely. Any healthcare reform effort that managed to completely eliminate the many causes of the disparity in epilepsy rates between the rich and poor — malnutrition, childhood trauma, early exposure to illness, stress, and so on  — would just as honestly be called a poverty eradication effort.

Rightly so, I think. As the place of brain sciences continues to expand and move into ever greater spheres of reason, the importance of neurological health continues to stake its claim to centrality. Epilepsy as a case study brings into focus the impact of poverty on a person’s very opportunity for health, and the impact is grim. Access to healthcare — even the best healthcare, even free healthcare — would doubtlessly improve the lives of poor people with epilepsy, but it wouldn’t shake out to equality between the rich and poor in the realm of the falling sickness. Poverty acts upon the totality of the person, and nothing demonstrates the improbability of piecemeal solutions to the effects of poverty like the case of epilepsy. When it comes to the dual strains of illness and poverty, healthcare reform is the treatment, and poverty eradication is the cure.