Antiepileptic drugs

Epilepsy Drugs: Newer Drugs, Types, Side Effects

Epilepsy is one of the most common neurological conditions, affecting more than 65 million worldwide. For those dealing with epilepsy, the advent of a seizure can feel like a ticking time bomb. It could happen at any time or any place, potentially posing a fatal risk when a seizure strikes during risky situations, such as while driving.

Epilepsy drugs, also known as antiepileptic drugs (AEDs) or antiseizure medications, are a class of medications used to manage and control seizures in individuals with epilepsy. These drugs work by stabilizing the electrical activity in the brain and reducing the likelihood of seizures.

There are many different epilepsy drugs available, and the choice of medication depends on various factors such as the type of seizures, the age of the patient, the presence of other medical conditions, and the potential side effects of the drug. Some commonly prescribed epilepsy drugs include:

1.      Carbamazepine (Tegretol): It is an older antiepileptic drug primarily used to treat focal (partial) seizures and generalized tonic-clonic seizures. It works by reducing the excessive electrical activity in the brain. Carbamazepine may also be prescribed for trigeminal neuralgia, a condition that causes intense facial pain.

Possible side effects include drowsiness, dizziness, nausea, skin rashes, and blood-related problems. It may also interact with other medications, so it’s important to inform your doctor about any other drugs you are taking.

2.      Valproic Acid (Depakote): This medication is effective for a wide range of seizure types, including absence seizures, myoclonic seizures, and generalized tonic-clonic seizures. It works by increasing the levels of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to reduce seizure activity.

Common side effects of valproic acid include gastrointestinal disturbances, weight gain, hair loss, tremors, and liver function abnormalities. It is not recommended for pregnant women or women of childbearing potential, as it may increase the risk of birth defects.

3.      Lamotrigine (Lamictal): It is commonly prescribed for focal (partial) seizures and generalized seizures, including absence seizures. Lamotrigine works by inhibiting the release of glutamate, a neurotransmitter involved in seizure activity.

Lamotrigine may cause side effects such as rash, dizziness, headache, and blurred vision. In rare cases, it can lead to a severe skin reaction called Stevens-Johnson syndrome or toxic epidermal necrolysis, particularly in individuals of Asian descent.

4.      Phenytoin (Dilantin): This drug has been used for many years as a first-line treatment for epilepsy. It is effective for focal seizures and generalized tonic-clonic seizures. Phenytoin works by blocking the spread of electrical activity in the brain.

Potential side effects of phenytoin include drowsiness, dizziness, coordination problems, gum overgrowth, and changes in hair growth. It may also cause blood-related problems and can interact with other medications.

5.      Levetiracetam (Keppra): It is used as an adjunct therapy for focal seizures and myoclonic seizures. Levetiracetam works by modulating neurotransmitter release and inhibiting the spread of abnormal electrical activity in the brain.

Common side effects of levetiracetam include drowsiness, dizziness, irritability, and weakness. It generally has a favorable side effect profile and does not have significant interactions with other medications.

Newer Epilepsy Drugs

Here are some examples of newer epilepsy drugs:

1.      Cannabidiol (CBD): CBD is a non-intoxicating compound derived from the cannabis plant. It has shown promise in treating certain types of epilepsy, such as Lennox-Gastaut syndrome and Dravet syndrome, in clinical trials. In some countries, specific CBD-based medications, such as Epidiolex, have been approved for the treatment of seizures associated with these conditions.

2.      Brivaracetam (Briviact): Brivaracetam is a newer antiepileptic drug that was approved for the treatment of partial-onset seizures in patients aged 16 years and older. It works by selectively binding to a receptor in the brain to reduce excessive electrical activity. Brivaracetam is typically used as an adjunctive therapy, meaning it is added to an existing treatment regimen.

3.      Perampanel (Fycompa): Perampanel is an antiepileptic drug that works by blocking a specific type of glutamate receptor in the brain, thereby reducing the excitability of neurons. It is approved for the treatment of partial-onset seizures and primary generalized tonic-clonic seizures in patients aged 4 years and older.

4.      Rufinamide (Banzel): Rufinamide is used as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome, a severe form of epilepsy that often begins in childhood. It helps to reduce seizure frequency and has been approved for use in both adults and children.

5.      Eslicarbazepine acetate (Aptiom): Eslicarbazepine acetate is indicated for the treatment of partial-onset seizures. It is thought to work by blocking voltage-gated sodium channels, thereby reducing the excessive electrical activity in the brain.

It’s important to note that the availability of newer epilepsy drugs can vary by country and regulatory approvals. Always consult with a healthcare professional for the most up-to-date information on the latest medications and their suitability for your specific condition.

How Are Epilepsy Drugs Taken

Epilepsy drugs can be taken in various forms, including tablets, capsules, liquid solutions, or injectable formulations. The specific form and dosing schedule depend on the medication prescribed and the individual’s needs. Here are the common methods of taking epilepsy drugs:

1.      Oral Tablets or Capsules: This is the most common form of medication for epilepsy. The tablets or capsules are swallowed whole with water. Some medications may need to be taken with food to improve absorption or reduce stomach irritation. It’s important to follow the prescribed dosage and timing instructions provided by the healthcare professional.

2.      Liquid Solutions: Some epilepsy drugs are available in liquid form, which can be especially helpful for individuals who have difficulty swallowing tablets or capsules. The liquid medication is usually measured using a syringe or a measuring cup and then swallowed.

3.      Chewable Tablets: Certain medications come in chewable tablet form, which can be chewed and swallowed without the need for water. This form is often used for children or individuals who have difficulty swallowing whole tablets.

4.      Intravenous (IV) Injection: In certain situations, such as during status epilepticus (prolonged seizures) or when oral medications cannot be taken, epilepsy drugs can be administered intravenously. This requires the medication to be injected directly into a vein by a healthcare professional.

It’s important to take epilepsy medications as prescribed and at the scheduled times to maintain consistent levels of the drug in the body. Missing doses or altering the dosage without medical supervision can lead to inadequate seizure control.

If there are any difficulties with taking the medication or concerns about the method of administration, it’s crucial to discuss them with a healthcare professional. They can provide guidance and, if necessary, explore alternative options to ensure the effective management of epilepsy.

How To Make Epilepsy Drugs More Effective

To make epilepsy drugs more effective, it’s essential to follow these guidelines:

1.      Take Medications as Prescribed: It’s crucial to take epilepsy medications exactly as prescribed by your healthcare professional. Follow the recommended dosage, frequency, and timing instructions consistently. Skipping doses or altering the dosage without medical supervision can lead to inadequate seizure control.

2.      Maintain a Regular Medication Schedule: Try to establish a routine for taking your epilepsy medications. Taking them at the same time each day can help maintain consistent levels of the drug in your system and optimize their effectiveness.

3.      Avoid Missed Doses: If you accidentally miss a dose, consult your healthcare professional for guidance on what to do. In some cases, they may recommend taking the missed dose as soon as you remember, while in other situations, it may be best to skip the missed dose and resume your regular schedule. Never double up on doses without medical advice.

4.      Be Patient and Give the Medication Time: Epilepsy medications often require time to reach their full therapeutic effect. It may take several weeks or even months to achieve optimal seizure control. Be patient and continue taking the medication as prescribed, even if you don’t notice immediate improvements.

5.      Communicate with Your Healthcare Professional: Regularly communicate with your healthcare professional regarding your epilepsy medication. Inform them about any changes in your seizure frequency or severity, side effects experienced, or concerns you may have. This information can help them make necessary adjustments to your treatment plan to improve its effectiveness.

6.      Avoid Triggers and Lifestyle Modifications: While medication is the primary treatment for epilepsy, certain triggers, and lifestyle factors can influence seizure activity. It may be helpful to identify and avoid triggers such as lack of sleep, excessive stress, alcohol consumption, or missed meals. Maintaining a healthy lifestyle with adequate sleep, stress management, and regular exercise can also contribute to overall seizure control.

7.      Regular Follow-ups and Medication Adjustments: Schedule regular follow-up appointments with your healthcare professional to monitor your response to the medication. They may need to adjust the dosage or consider alternative medications if seizure control is not achieved or if side effects are problematic.

8.      Consideration of Other Treatment Options: In some cases, epilepsy medications alone may not provide adequate seizure control. Your healthcare professional may explore additional treatment options, such as adding complementary medications, considering surgical interventions, or recommending other therapies like the ketogenic diet or vagus nerve stimulation.

Remember that the effectiveness of epilepsy medications can vary from person to person, and finding the most suitable treatment may involve some trial and error. Close collaboration with your healthcare professional is crucial to developing an individualized treatment plan that maximizes the effectiveness of the medications in managing your epilepsy.


Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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