Seizure Medications

A seizure occurs when there is abnormal electrical activity in the brain. Seizures are also known as convulsions – but not all seizures produce convulsive behavior – that is uncontrollable muscle contractions. Absence seizures, for example, involve brief periods of staring. With atonic seizures, there is a loss of muscular tone or strength. The symptoms produced by a seizure are dependent on which part of the brain is experiencing the abnormal electrical activity. Seizures are generally short-lived – from 15 seconds to 15 minutes – however; there is a life-threatening type of seizure, status epilepticus, in which the seizure does not stop.

A variety of conditions and substances can trigger seizures. Common causes include

• congenital abnormalities of the brain,
• illicit drug use, fever,
• brain tumors and metabolic imbalances, such as high levels of glucose or sodium.
• Epilepsy is a condition in which a person experiences repeated seizures, due to an overall electrical disturbance in the brain.

AMPA Receptor Antagonist

• Perampanel (Fycompa)

Calcium Channel Modulators

• Levetiracetam (Keppra, Keppra XL)

Carbonic Anhydrase Inhibitor

• Acetazolamide (Diamox)

Carboxamides

• Carbamazepine (Tegretol)
• Eslicarbazepine (Aptiom)
• Oxcarbazepine (Trileptal)
• Rufinamide (Banzel)

GABA Analogs

• Gabapentin (Neurontin)
• Pregabalin (Lyrica)
• Progabide (Gabrene)
• Vigabatrin (Sabril)

GABA Reuptake Inhibitors

• Tiagabine (Gabitril)

K-Channel Opener

• Ezogabine/Retigabine (Potiga)

NMDA Receptor Blockers

• Felbamate (Felbatol)
• Sodium Channel Modulators
• Lacosamide (Vimpat)
• Lamotrigine (Lamictal)
• Phenytoin (Dilantin)

Succinimides

• Ethosuximide (Zarontin)
• Methsuximide (Celontin)

Sulfamate-Substitute Monosaccharides

• Topiramate (Topamax, Topamax ER, Qudexy XR)

Sulfonamides

• Zonisamide (Zonegran)

Valproic Acid

• Divalproex Sodium (Depakote)
• Valproic Acid (Depakene)

Barbiturates

• Phenobarbital
• Primidone (Mysoline)

Benzodiazepines

• Clobazam (Onfi)
• Clonazepam (Klonopin, Epitril, Rivotril)
• Diazepam (Valium, Diastat)
• Lorazepam (Ativan)

First-line therapy for generalized tonic-clonic (grand mal) seizures includes

• valproic acid (Depakene, Depakote),
• lamotrigine (Lamictal), and
• topiramate (Topamax).

For partial seizures, common first-line medications include

• carbamazepine (Tegretol),
• phenytoin (Dilantin),
• Oxcarbazepine (Trileptal) and
• especially in children, ethosuximide (Zarontin).

Additionally, phenobarbital is often the medication of choice for seizures in very young children.

Because seizure medications work in the central nervous system, most cause some degree of drowsiness or dizziness, at least at the beginning of therapy. Also, most anti-seizure medications can induce suicidal thoughts or actions, and/or bring on or worsen depression.

Seizure medications have a variety of possible side effects. The following is a list of potential side effects of different classes of seizure medications.

Acetazolamide (Diamox):

• Kidney stones
• Increased urination
• Loss of potassium

Benzodiazepines (Valium, Ativan, Klonopin, Onfi):

• Dependence
• Possible severe seizures on sudden withdrawal
• Respiratory depression
• Increased risk of glaucoma
• Liver injury

Carbamazepine (Tegretol) and related drugs:

• Upset stomach
• Serious (even fatal) skin reactions
• Serious blood disorders
• Reduced sodium levels (oxcarbazepine)

Ethosuximide (Zarontin) and derivatives:

• Serious blood disorders

Ezogabine/Retigabine (Potiga):

• Potentially irreversible eye damage
• Potentially irreversible skin discoloration

Felbamate (Felbalol):

• Liver failure
• Potentially fatal anemia (aplastic anemia)

Gabapentin (Neurontin):

• Weight gain
• Behavioral changes including hyperactivity

Lacosamide (Vimpat):

• Skin rash
• Changes in heartbeat with possible fainting
• Drug dependence

Lamotrigine (Lamictal):

• Serious rash
• Stomach problems
• Difficulty sleeping

Levetiracetam (Keppra, Keppra XR):

• Headache
• Flu-like symptoms
• Weight loss
• Changes in behavior
• Changes in blood count

Perampanel (Fycompa):

• Severe changes in mood and behavior, including hostility, aggression, suicidal thoughts
• Weight gain
• Drug dependence

Phenobarbital and derivatives:

• Birth defects
• Memory loss
• Depression

Phenytoin (Dilantin):

• Body hair growth
• Birth defects
• Gum disease
• Seizures with higher doses

Pregabalin (Lyrica):

• Swelling of hands and feet
• Trouble concentrating
• Weight gain

Rufinamide (Banzel):

• EKG changes
• Interference with oral contraceptives

Tiagabine (Gabitril):

• Tremor
• Agitation
• Seizures in non-epilepsy patients

Topiramate (Topamax):

• Increased risk for glaucoma
• Trouble concentrating
• Decreased sweating
• Increase in body temperature

Valproic acid and derivatives (Depakene, Depakote):

• Stomach upset
• Temporary loss or thinning of hair
• Pancreatitis
• Toxicity to liver
• Weight gain
• Birth defects

Vigabatrin (Sabril):

• Irreversible visual problems, including reductions in acuity and color differentiation

Zonisamide (Zonegran):

• Kidney stones
• Rise in body temperature
• Metabolic acidosis

The best seizure medication is one that treats the particular type of seizure a patient is experiencing.

• Some seizure medications work best on generalized tonic-clonic seizures (grand mal seizures). These are the kind of seizures typically seen with epilepsy.
• Others are more effective at controlling partial or absence (petit mal) seizures.

Some seizure medications are considered first-line therapy, while others are approved as "add-ons" when further seizure control is needed.

Some seizure medications are potentially dangerous to administer to young children – such as valproic acid (Depakote, Depakene).

Sometimes, certain medications work better than others for unusual seizure situations. For example, women who develop an increase in seizure activity around menstruation can benefit from using acetazolamide (Diamox).

Also to be considered is whether the patient is, or might become, pregnant during therapy. Some seizure medications, including phenytoin and valproic acid, can harm the developing fetus.

Some seizure medications should only be used when other options run out – as they carry significant potential for serious side effects.

Two seizure medications are also used to prevent migraine headaches:

• Valproic acid (Depakene, Depakote) and
• topiramate (Topamax).

Some studies suggest using these medications can significantly reduce the number of migraine headaches.

• The seizure medication of choice in infants and toddlers is phenobarbital.
• Conversely, valproic acid (Depakene, Depakote) use in children under two should be avoided, as there is a heightened risk of liver failure. That risk decreases the older a child gets.
• Other seizure medications commonly used in children include phenytoin (Dilantin) and carbamazepine (Tegretol).
• Several seizure medications can be used to treat Lennox Gastaut Syndrome – a severe form of epilepsy that affects children.
  • Clobazam (Onfi), which reduces anxiety as well as seizures, is usually paired with such seizure medications as lamotrigine (Lamictal), felbamate (Felbalol), topiramate (Topamax), and valproic acid (Depakene, Depakote) to treat the disorder.

• Some seizure medications can harm the developing fetus, including
  • valproic acid (Depakote, Depakene),
  • phenytoin (Dilantin),
  • carbamazepine (Tegretol),
  • phenobarbital, and
  • topiramate (Topamax).
• Possibly safer options during pregnancy include
  • lamotrigine (Lamictal),
  • levetiracetam (Keppra), and
  • gabapentin (Neurontin).
• Additionally, some seizure medications can decrease the effectiveness of oral contraceptives.

All seizure medications can cause drowsiness and dizziness – especially early in therapy. Alcohol has the potential to enhance those side effects.

• Drinking alcohol while on seizure medications is not forbidden. But it should be done in moderation only.
• Heavy or binge drinking can lead to alcohol withdrawal – and that can trigger sometimes life-threatening seizures.

Benzodiazepines have both antiseizure and anti-anxiety activity. These drugs include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin) and Clobazam (Onfi).

The danger with using these drugs long term is their addictive potential.

Sudden withdrawal from a benzodiazepine can trigger seizures.

REFERENCES:

http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912003/

http://www.ncbi.nlm.nih.gov/pubmed/11576201

http://epilepsy.med.nyu.edu/treatment/medications/valproate#sthash.9KtFTUZq.dpbs

http://www.ninds.nih.gov/disorders/lennoxgastautsyndrome/lennoxgastautsyndrome.htm

http://mnepilepsy.org/patient-information/relative-safety-of-seizure-medications-during-pregnancy/

http://www.epilepsy.com/learn/triggers-seizures/alcohol

http://epilepsy.med.nyu.edu/living-with-epilepsy/related-disorders/anxiety-and-epilpsy#sthash.AWWsvw6z.dpbs