Most patients will respond to one or two different medication trials. The goal of this treatment is the elimination of seizures, since uncontrolled seizures carry significant risks, including injury and sudden death. However, in up to one third of patients with epilepsy, medications alone will be unable to eliminate seizures, or cause unacceptable adverse effects. In these patients, work up for the feasibility of epilepsy surgery is considered.
Although many patients have seizure control using a single medication, others require multiple medications, resective surgery, neuromodulation devices or dietary therapies.
Antiepileptic drugs (AEDs) remain the primary treatment strategy to suppress seizure activity, but do not address the underlying neuropathological process. While surgical intervention— such as neuromodulation or resection— is an option for some of these patients, many require long-term AEDs for seizure control 2).
Conventional antiepileptic drugs suppress the excessive firing of neurons during seizures. In drug-resistant patients, treatment failure indicates an alternative important epileptogenic trigger.
Anticonvulsants (also commonly known as antiepileptic drugs or as antiseizure drugs) are a diverse group of pharmaceuticals used in the treatment of epileptic seizures.
Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and for the treatment of neuropathic pain.
Anticonvulsants suppress the rapid and excessive firing of neurons during seizures. Anticonvulsants also prevent the spread of the seizure within the brain. Some investigators have observed that anticonvulsants themselves may cause reduced IQ in children.
However these adverse effects must be balanced against the significant risk epileptic seizures pose to children and the distinct possibility of death and devastating neurological sequelae secondary to seizures. Anticonvulsants are more accurately called antiepileptic drugs (abbreviated “AEDs”), and are often referred to as antiseizure drugs because they provide symptomatic treatment only and have not been demonstrated to alter the course of epilepsy.
There is increasing emphasis on untangling the interactive forces of new antiepileptic medications from epilepsy/seizures on the neurophysiological, neuropsychologic and psychiatric/behavioral functioning of individuals with epilepsy. The role of GABA in the pathophysiology of seizures and status epilepticus has led to novel therapy proposals.
Anti-epileptic drugs (AEDs) are the main form of treatment for people with epilepsy. And up to 70% (7 in 10) people with epilepsy could have their seizures completely controlled with AEDs. There are around 26 AEDs used to treat seizures, and different AEDs work for different seizures. Here we explain what the different AEDs are, what type of seizures or epilepsy they are used for, as well as some essential information about average doses and common side effects.
There are three ways you can search for information about AEDs:
by the generic name of the AED by the brand name of the particular type of AED or by the type of seizure or seizures you have.
Absence seizures (including typical and atypical absences): Acetazolamide | Clonazepam | Ethosuximide | Lamotrigine | Sodium valproate
Atonic seizures: Phenobarbital | Phenytoin | Primidone | Sodium valproate
Catamenial seizures (menstrual-related): Acetazolamide | Clobazam
Cluster seizures: Clobazam
Episodic disorders: Acetazolamide
Dravet syndrome (severe myoclonic epilepsy in infancy or SMEI): Stiripentol
Focal (partial) seizures: Acetazolamide | Carbamazepine | Clobazam | Clonazepam | Eslicarbazepine acetate | Gabapentin | Lacosamide | Lamotrigine | Levetiracetam | Oxcarbazepine | Perampanel | Phenobarbital | Phenytoin | Pregabalin | Primidone | Retigabine | Sodium valproate | Tiagabine | Topiramate | Vigabatrin | Zonisamide
Focal (partial) seizures with secondary generalisation: Gabapentin | Lacosamide | Levetiracetam | Perampanel | Phenobarbital | Phenytoin | Pregabalin | Primidone | Retigabine | Sodium valproate | Tiagabine | Topiramate | Vigabatrin | Zonisamide
Focal seizures with secondary generalised tonic clonic seizures: Carbamazepine | Eslicarbazepine acetate | Lamotrigine | Oxcarbazepine
Infantile spasms: Nitrazepam | Sodium valproate | Vigabatrin
Juvenile Myoclonic Epilepsy (seizures related to): Levetiracetam
Lennox-Gastaut syndrome (seizures related to): Lamotrigine | Rufinamide | Topiramate
Menstrual-related (catamenial seizures): See: Catamenial seizures (above)
Myoclonic seizures: Clonazepam | Ethosuximide | Phenobarbital | Phenytoin | Primidone | Piracetam | Sodium valproate
Myoclonic seizures in Juvenile Myoclonic Epilepsy: See: Juvenile Myoclonic Epilepsy (above)
Tonic seizures: Phenobarbital | Phenytoin | Primidone | Sodium valproate
Tonic clonic seizures: Acetazolamide | Carbamazepine | Clobazam | Clonazepam | Eslicarbazepine acetate | Lamotrigine | Phenobarbital | Phenytoin | Primidone | Sodium valproate | Topiramate
Tonic clonic seizures in severe myoclonic epilepsy in infancy (SMEI or Dravet syndrome): See: Dravet syndrome (above)
West Syndrome with Tuberous Sclerosis: Vigabatrin
Patients with epilepsy are frequently required to take antiepileptic drugs (AEDs) for a long period of time. Many studies have shown that AEDs have a negative influence on endocrine function including the thyroid gland.