About Antiepileptic Drugs

About Antiepileptic Drugs

AEDs act on brain signaling to control and subside hyperexcitability in epileptic tissue in the brain. Unfortunately AEDs do not cure epilepsy, but they allow many people to live normal active lives, free or nearly free of seizures.

Not all patients with seizures require treatment with antiepileptic drugs throughout their lives. Most patients with epilepsy, however, will require one or more drugs for many years. Overall, there is about a 60-70 % chance of good seizure control with a single drug. About 30 % patients with epilepsy will not have good seizure control with single medication and will require addition of other AEDs.

There are many different AEDs approved for the treatment of seizures. The goal of treatment is the best seizure control with the least possible number of AEDs. Using two medications may improve seizure control, but can also greatly increase the chance of side effects.

Certain medications work best for certain types of seizures. Choosing the best medication for you will require taking many factors in consideration. This may require trying few AEDs until finding the best regimen or possible combination to control your seizures. It is generally agreed that using a single medication is best, when possible.

The most commonly used antiepileptic medications are listed below. Since antiepileptic drugs work by decreasing brain “hyperactivity,” it is common that many side effects are related to dulling of normal brain “activity.” Therefore, nearly all the antiepileptic drugs can cause sleepiness, difficulty with concentration and memory, blurred vision, and trouble with balance in some patients.

The “new” antiepileptic medications (Levetiracetam, Gabapentin, Lamotrigine, Topiramate, Pregabalin, Tiagabine, Lacosamide, Rufinamide) may be better tolerated than older medications.

Old Antiepileptic Drugs:

  • phenobarbital
  • phenytoin (Dilantin)
  • primidone (Mysoline)
  • carbamazepine (Tegretol)
  • valproate (Depakote)
  • felbamate (Felbatol)
  • gabapentin (Neurontin)

New Antiepileptic Drugs:

  • lamotrigine (Lamictal)
  • topiramate (Topamax)
  • tiagabine (Gabitril)
  • oxcarbazepine (Trileptal)
  • levetiracetam (Keppra)
  • zonisamide (Zonegran)
  • vigabatrin
  • pregabalin (Lyrica)
  • rufinamide (Banzel)
  • Lacosamide (Vimpat)

How My Doctor Decides About The Best Medication For Me?

Your epilepsy physician considers multiple factors in deciding the most appropriate medication to treat your disease. These factors include age, gender, type of seizures, type of epilepsy syndrome, your other medical conditions, other medications you are on, your daily activity level, side effect profile, potential of pregnancy, need for breast feeding, and others.

Some AEDs are not the drug of choice to treat some types of seizures. For example, gabapentin, pregabalin, phenytoin, carbamazepine may make your seizures worse if you have myoclonic or absence seizures.  Lamotrigine may also decrease absence seizures control. So your doctor will choose the best medication to treat your seizures after considering all these factors mentioned.

The following table summarizes different spectrum of actions of antiepileptic drugs and choice of AEDs according to type of seizures:

Narrow-Spectrum of Action Broad-Spectrum of Action
Type of seizures to treat Partial or Secondarily
Generalized Seizures
Tonic-Clonic Seizures, Partial
and Generalized Seizures
Antiepileptic Drugs Carbamazepine
Gabapentin
Lacosamide
Oxcarbazepine
Phenobarbital
Phenytoin
Pregabalin
Primidone
Tiagabine
Lamotrigine
Levetiracetam
Rufinamidea
Topiramate
Valproate
Zonisamideb

 

What Are The Side Effects Of Antiepileptic Drugs?

Some common and serious side effects are listed below. As with all medications, you should discuss potential side effects fully with your doctor prior to beginning any antiepileptic medication.

There is a black box warning by FDA regarding increased risk of suicidal ideation associated with antiepileptic use in epilepsy patients. This result was concluded from drug trials for new investigational drugs to treat epilepsy.

Antiepileptic drug Common side effects Serious side effects
Carbamazepine Dizziness, double vision,  blurred vision, gait disturbance, low sodium level, low blood cell count Bone marrow suppression, liver failure, Stevens-Johnson syndrome
Phenytoin Fatigue, dizziness, gait disturbance, nausea, confusion, gingival hyperplasia, hirsutism, osteopenia, rash Stevens-Johnson syndrome, toxic, blood dyscrasias, pseudolymphoma,lupus-like syndrome
Valproate Drowsiness, gait disturbance, tremor, weight gain, hair loss, low platelet countincreased ammonia level Hepatic failure, pancreatitis, bone marrow failure, blood dyscrasias, lupus-like syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis
Oxcarbazepine Dizziness, double vision, blurred vision, headache, nausea, low sodium level Stevens-Johnson syndrome, toxic epidermal necrolysis
Lamotrigine Dizziness, double vision, blurred vision, insomnia, headache, rash, fatigue, dizziness, somnolence, Stevens-Johnson syndrome, toxic epidermal necrolysis, multiorgan failure, liver failure
Levetiracetam Irritability, mood swings Psychosis
Pregabalin Fatigue, dizziness, gait disturbance, double vision, weight gain, edema None reported
Topiramate Drowsiness, gait disturbance, word-finding difficulty, difficulty concentrating, anorexia,weight loss, pins and needles like sensation in limbs and on face Kidney stones, metabolic acidosis, decreased sweating, acute close angle glaucoma, heatstroke
Zonisamide Drowsiness, gait disturbance, difficulty concentrating, anorexia, weight loss, nausea, kidney stones, decreased sweating Aplastic anemia, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, heat stroke
Rufinamide Somnolence, headache, dizziness, double vision, fatigue, nausea Shortened QT interval (no known clinical risk), multiorgan hypersensitivity
Lacosamide Dizziness, double vision, blurred vision, headache, nausea PR interval prolongation, atrial fibrillation, atrial flutter, ultiorgan hypersensitivity

Tips Not To Forget To Take Your Medication

  1. Use a pill box with separate compartments for each day of the week. day and night sections of each day can be a big help. In this way you can keep track of the pills you’ve taken and the ones you haven’t.
  2. Use a timer of your watch, computer, or daily organizer to remind you to take your medications.
  3. Create your own habitAssociate taking your medication to a routine daily activity. For example, you may take your medications right after brushing your teeth in the morning or before preparing your bed at night.
  4. Writing down your medication doses and schedule on a calendar in a sense, will help you remember to take your medicine.

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