Anti-Epilepsy Drugs and Their Side-Effects, You Must Want To Know

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For people with epilepsy, Anti-Epilepsy Drugs (AEDs) are the most common method used to control seizures. Although there are more than 40 different types of epilepsy, the right medication or combination of medications can usually control seizures.  However 30% of people are drug resistant, owing to either their gene factors or biological makeup.

The most important consideration in your treatment is identifying the exact type of epilepsy you have, therefore you may want to consult more than one doctor.

Medications prescribed will also depend on factors such as which side-effects you can actually tolerate, other illnesses you may have, and how the drug should be taken.

It may take several months before the best drug and dosage are determined for you. After all, medicine is more of an art than a science.  And finding the right combination can literally be a crap shoot.  I know for me and many others, it took many months to get it “right.”

However, during this adjustment period, you must be carefully monitored with frequent blood tests to measure your response to the medication.

It’s also essential that you note any side-effects you experience, (keeping a daily diary is good for this) whether it’s related to health, behavior, or moods.  And please be sure to share these with your doctor, so he can get an accurate picture of what you’re going through.

One more mantra: KEEP YOUR DOCTORS’ APPOINTMENTS!  Whether it’s a diagnostic test, follow-up or regular progress report.  These appointments are necessary to see if the drug is working for you…how your body is tolerating it…and if you are at risk for serious side effects or complications.

Here’s a list of some of the most common drugs currently used to treat epilepsy:

Acetazolamide: Acetazolamide is effective for focal, tonic clonic and absence seizures. It’s also used for menstrual-related seizures, certain episodic disorders and to enhance other AEDs. Most common possible side effects include the following: Severe reactions, such as a skin rash. Nausea, vomiting, diarrhea, taste disturbance, loss of appetite, pins and needles, flushing, headache, dizziness, fatigue, irritability, excitement, unsteadiness, depression, thirst, increased urination, and reduced libido. Tolerance may develop.

Aptiom (Eslicarbazepine Acetate): Aptiom is an antiepileptic drug indicated as adjunctive treatment of partial-onset seizures. Common side-effects of Aptiom include: dizziness,  drowsiness, nausea, headache, double vision, vomiting, fatigue, vertigo, loss of coordination and balance, blurred vision, tremor, diarrhea, constipation, abdominal pain, weakness, swelling of the extremities, urinary tract infection, difficulty speaking, memory problems, involuntary eye movements, depression, insomnia, cough, rash, high blood pressure,  and the increased risk of suicidal thoughts or behavior.

Ativan (lorazepam): Ativan is similar to Clonazepam in dosage and action, but it is not as long-acting. It is usually used as a ‘rescue medication’ for patients who frequently have clusters of seizures. It works reasonably quickly when taken orally and the anti-seizure effect lasts for 2-6 hours. An Ativan concentrate, 2 mg per ml, can be taken as 1 ml liquid under the tongue in urgent situations.

Banzel (Rufinamide Inovelon in Europe): Banzel is approved as an add-on treatment for children age 4 and older and adults with the Lennox Gastaut Syndrome . This syndrome can include seizure types such as atonic (drop) seizures, tonic (stiffening) seizures, myoclonic (brief jerking) seizures, or staring (absence) seizures, as well as partial seizures. Common side-effects include headache, dizziness, fatigue and sleepiness, double vision and trembling. People who have a heart rhythm irregularity, should not take Banzel.

Briviact (Brivaracetam): Briviact has been approved for the adjunctive treatment of partial-onset seizures in patients 16 years and older. Briviact is the first antiepileptic drug  for partial seizures, approved by the FDA since the 2013 approval of eslicarbazepine (Aptiom).  Common side-effects of Briviact include drowsiness, sedation, dizziness, fatigue, nausea, vomiting, loss of balance or  coordination, irritability, and constipation. May increase the risk of suicidal thoughts or behavior.

Depakote (Depakene, Valproate, Valproic Acid): Depakote is considered one of the most effective medications for treating generalized seizure types such as partial, absence, and generalized tonic-clonic seizures. Some of the common side-effects include dizziness, nausea, vomiting, tremor, hair loss, weight gain, depression in adults, irritability in children, reduced attention, and a decrease in thinking speed. Over the long term, the drug can cause bone thinning, swelling of the ankles, irregular menstrual periods. More rare and dangerous effects include hearing loss, liver damage, decreased platelets (clotting cells), and pancreas problems.

Dilantin (Phenytoin): Dilantin is used to control partial seizures and generalized tonic-clonic seizures. It also can be given intravenously in the hospital to rapidly control active seizures.  Interestingly, Dilantin is the most prescribed AED by general physicians in the U.S. but less so among epilepsy doctors, because of its side-effects. Common side-effects are unsteadiness and moderate cognitive problems, dizziness, fatigue and slurred speech. There are also long-term potential cosmetic (body/face hair growth, skin problems), and bone problems (osteoporosis). Phenytoin can also cause a rare and dangerous rash called Stevens-Johnson syndrome.

Epilim (Sodium Valproate): Effective for all types of seizures. Most common possible side-effects include the following: severe reactions, such as a skin rash, which should be immediately reported to your doctor. Hair loss – not usually severe and is usually reversible if the dose is reduced. Nausea, stomach upset, diarrhea, and weight gain (due to increased appetite), increased levels of ammonia in the blood, and reduced platelets in the blood. Has been associated with polycystic ovaries and menstrual problems. Sodium valproate carries a higher risk than other AEDs of causing developmental problems in unborn babies if taken during pregnancy. Having preconceptual counselling is recommended.

Felbatol: Felbatol treats partial and some generalized seizures. Side-effects include decreased appetite, weight loss, inability to sleep, headache, and depression. In rare cases, the drug can cause bone marrow loss or liver failure. Therefore, use of the drug is limited.  And if you are taking it, you must have blood cell counts and liver tests regularly.

Fycompa (Perampanel): is an anticonvulsant used to treat seizures in adults and children who are at least 12 years old. This AED is used to treat partial-onset seizures with or without secondarily generalized seizures, and for use with other medications to treat primary generalized tonic-clonic (PGTC) seizures. Side-effects include: abnormal gait, aggressive behavior, dizziness, drowsiness, equilibrium disturbance, falling, hostility, ataxia, fatigue, and irritability. Other side-effects include: anxiety, back pain, blurred vision, vertigo, and weight gain.

Gabitril: Gabitril is used with other epilepsy drugs to treat partial and some generalized seizures. Common side-effects include dizziness, fatigue, weakness, irritability, anxiety, and confusion.

Keppra (Levetiracetam): Keppra is one of the more used medicines in seizure clinics because it’s usually effective for a broad-spectrum of seizures types.  It has a relatively low incidence of causing thinking/memory problems and has no drug interactions. The most common side-effects are dizziness, fatigue and insomnia, but the more troublesome problem can be irritability and mood changes. This may occur to some degree in up to a third of those taking the medicine.

Klonopin (Clonazepam):  Klonopin is in the  same family as Valium (Diazepam), Ativan (Lorazepam), Tranxene (Clorazepate), Xanax (Alprazolam). They are often used in the emergency room to stop a seizure and are effective in short-term treatment of all seizures. Tolerance usually develops within a few weeks, so the same dose has less influence over time. Klonopin appears to be more long-acting against seizures than Valium or Ativan. Side-effects of Klonopin include tiredness, unsteady walking, nausea, mood changes, loss of appetite and addiction.

Lamictal (lamotrigine): Lamictal treats partial and some generalized seizures, but it may not be as effective for myoclonic seizures.   Its side-effects include dizziness, fatigue, insomnia and mild cognitive (thinking) impairment. In rare cases, it can cause Stevens-Johnson syndrome which poses a dangerous risk if not treated immediately. Doses should be increased slowly to avoid any complications.  Lamictal is also used for mood stabilization.

Lyrica (Pregabalin): Lyrica is used to treat partial seizures and chronic pain of certain types.  A relative of gabapentin, it may work better, and can be given twice a day. Some believe that it is more effective against seizures than gabapentin.  The good news is that it has no drug interactions  Side-effects include dizziness, sleepiness, dry mouth, peripheral edema, blurred vision, weight gain, and difficulty with concentration and attention.

Neurontin (Gabapentin):  Neurontin is used with other epilepsy drugs to treat partial and some generalized seizures. It has the reputation of being a safe but not particularly powerful AED. The effectiveness criticism probably is because it’s often prescribed at too low a dose.  Side-effects include unsteadiness, weight gain, fatigue and dizziness, but are rarely lasting.  Neurontin is also often used for chronic pains of certain types.

Onfi (Clobazam): This medication is used with other medications to help control seizures. It belongs to a class of medications called benzodiazepines, which act on the brain and central nervous system to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA). Drowsiness, dizziness, tiredness, headache, constipation, weight gain, fever, cough, drooling, trouble sleeping, or nausea may occur. If any of these effects persist or worsen, tell your doctor promptly.

Phenobarbital (Luminal): This old-timer is very inexpensive and effective in a single daily dose.  Unfortunately, side-effects include sedation, thinking/memory problems and depression. Phenobarbital can also cause long-term bone problems. It’s mildly addictive and requires slow withdrawal. And it is not suitable for pregnant mothers because there is a significant rate of birth defects.

Sabril (Vigabatrin): Sabril has been used for over a decade in many countries, and it is effective for partial seizures.  It also may be very effective for infantile spasms, a serious type of seizures in young children. Release in the U.S. was delayed because the drug is toxic to the retina of the eye in up to 30% of people who take it long-term. This toxicity can result in permanent loss of peripheral vision. Regular vision testing is recommended for all people on this drug.

Tegretol (Carbamazepine or Carbatrol):  Tegretol is the first choice for partial, generalized tonic-clonic and mixed seizures. Long-acting forms can be given once a day.  Potential side-effects include nausea, dizziness, fatigue, weight gain, blurred vision, low blood counts and low blood sodium.  In a few percent of people, Tegretol can cause a rash, sometimes even the dangerous Stevens-Johnson syndrome. People of Asian descent with HLA-B*1502 antigen are more at risk.

Topamax (Topiramate): Topamax can be used as a general AED to suppress seizures or in combination with other drugs to treat partial or generalized tonic-clonic seizures.  Side-effects include sleepiness, dizziness, speech problems, nervousness, memory problems, visions problems and weight loss.

Trileptal (Oxcarbazepine): Trileptal is slightly different from Tegretol, however it is at least as effective in treating partial seizures and may have fewer side-effects, except for more risk of low blood sodium, fatigue, dizziness, headache and blurred vision.

Vimpat (lacosamide): Vimpat is a new entry into the AED arena, first introduced in 2009. It’s effective for partial and secondarily generalized seizures. Side-effects include dizziness, headache, nausea or vomiting, double vision, fatigue, memory or mood problems.  In rare cases, Vimpat may affect internal organs, blood counts or heart rhythm, but these potentially serious side-effects are infrequent.

Zarontin (ethosuximide):  Zarontin is used to treat absence seizures.  Adverse effects include nausea, vomiting, decreased appetite, and weight loss.

Zonegran (zonisamide): Zonegran is used in combination with other drugs to treat partial seizures. It’s similar in its coverage to Topamax with side-effects including drowsiness, dizziness, unsteady gait, kidney stones, abdominal discomfort, headache, and rash.

Another article of interest:

Anti-epilepsy drugs can cause inflammations http://www.medicalnewstoday.com/releases/270543.php

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Resources:

http://www.epilepsyfoundation.org/about/treatment/medications/index.cfm

http://www.webmd.com/epilepsy/medications-treat-seizures

https://www.epilepsysociety.org.uk/acetazolamide#.We959GhSztU

https://www.medscape.com/viewarticle/869575

https://www.webmd.com/drugs/2/drug-158687/onfi-oral/details#side-effect

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