Seizure Medications

Aseizureoccurs when there isabnormalelectrical activityinthebrain. Seizures are also known as convulsions – but not all seizures produce convulsive behavior – that is uncontrollablemusclecontractions. Absence seizures, for example, involve brief periods of staring. Withatonicseizures, there is a loss ofmusculartone 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 cantriggerseizures. Common causes include

• congenitalabnormalities of the brain,
• illicit drug use,fever,
• 脑部肿瘤和metabolicimbalances, such as high levels ofglucose或sodium.
• Epilepsyis aconditionin 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, TopamaxER,Qudexy XR)

Sulfonamides

• Zonisamide(Zonegran)

Valproic Acid

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

Barbiturates

• Phenobarbital
• Primidone(Mysoline)

Benzodiazepines

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

First-linetherapyfor 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药物治疗of choice for seizures in very young children.

Becauseseizure medicationswork in thecentral nervous system, most cause some degree of drowsiness ordizziness, at least at the beginning of therapy. Also, mostanti-seizure medications can inducesuicidalthoughts or actions, and/or bring on or worsendepression.

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):

• Kidneystones
• Increased urination
• Loss ofpotassium

Benzodiazepines (Valium, Ativan, Klonopin, Onfi):

• Dependence
• Possible severe seizures on sudden withdrawal
• Respiratory depression
• Increased risk ofglaucoma
• Liverinjury

Carbamazepine (Tegretol) and related drugs:

• Upsetstomach
• Serious (even fatal)skinreactions
• Seriousblooddisorders
• Reduced sodium levels (oxcarbazepine)

Ethosuximide (Zarontin) and derivatives:

• Serious blood disorders

Ezogabine/Retigabine (Potiga):

• Potentially irreversibleeyedamage
• Potentially irreversible skin discoloration

Felbamate (Felbalol):

• Liver failure
• Potentially fatalanemia(aplastic anemia)

Gabapentin (Neurontin):

• Weight gain
• Behavioral changes includinghyperactivity

Lacosamide (Vimpat):

• Skinrash
• 的变化与pos心跳siblefainting
• Drug dependence

Lamotrigine (Lamictal):

• Serious rash
• Stomach problems
• Difficulty sleeping

Levetiracetam (Keppra, Keppra XR):

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

Perampanel (Fycompa):

• 严重的情绪和行为的变化,包括累积量tility, aggression, suicidal thoughts
• Weight gain
• Drug dependence

Phenobarbital and derivatives:

• Birth defects
• Memoryloss
• Depression

Phenytoin (Dilantin):

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

Pregabalin (Lyrica):

• Swelling of hands andfeet
• Trouble concentrating
• Weight gain

Rufinamide (Banzel):

• EKG changes
• Interference with或alcontraceptives

Tiagabine (Gabitril):

• 地震
• Agitation
• Seizures in non-epilepsy patients

Topiramate (Topamax):

• Increased risk for glaucoma
• Trouble concentrating
• Decreasedsweating
• Increase in bodytemperature

Valproic acid and derivatives (Depakene, Depakote):

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

Vigabatrin (Sabril):

• Irreversible visual problems, including reductions in acuity and colordifferentiation

Zonisamide (Zonegran):

• Kidney stones
• Rise in body temperature
• Metabolicacidosis

The best seizure medication is one that treats the particular type of seizure apatientis 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控制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 aroundmenstruationcan benefit from using acetazolamide (Diamox).

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

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 preventmigraineheadaches:

• 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 GastautSyndrome– a severe form of epilepsy that affects children.
  • Clobazam (Onfi), which reducesanxietyas 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 duringpregnancyinclude
  • 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.Alcoholhas 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 orbinge drinkingcan lead to alcohol withdrawal – and that can trigger sometimes life-threatening seizures.

Benzodiazepineshave 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