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What are AEDs?
Medicines known as antiepileptic drugs (AEDs) help
control the frequency and severity of seizures. There
are several AEDs available, because each works in different
ways and has proven effective for certain types of epilepsy.
While one medicine may be helpful in controlling partial
seizures, it may make another type of seizure worse.
When doctors prescribe an AED, therefore, many factors
are taken into account including: the patient’s
age and gender; seizure type (which can be determined
with an EEG); and medical history. For the medication
to work most effectively, the patient must take it according
to the doctor’s directions. Periodic blood tests
measure the amount of AED in the blood; these blood
levels can help determine whether the patient is receiving
too much or too little of the drug, or even if another
medication is needed to control seizures.
While generic drug substitutions may be acceptable
for other medical conditions, people with epilepsy should
check with their doctor first before accepting a generic
AED. Generic drugs cost less, but the therapeutic range
between "brand" and generic AEDs may be too
broad, causing a loss of seizure control.
Types of AEDs
The family of antiepileptic drugs (AEDs) includes medications
that have been used for decades in the treatment of
epilepsy, as well as newer therapies. A brief description
of some of these medicines and their potential side
effects appears below. The side effects listed are in
addition to the fatigue, sedation, and cognitive impairment
that can occur with many seizure medicines.
Depakote (valproic
acid): Depakote is used to treat patients with multiple
seizure types, absence seizures, myoclonic epilepsy,
and generalized epilepsy. This medicine comes in tablets
and as a powder that can be sprinkled on foods.
Side Effects: loss of appetite when beginning the
drug; slight hand tremor; anemia; decrease in blood
platelet count; liver inflammation.
Dilantin (phenytoin):
One of the older AEDs, Dilantin is prescribed for patients
with generalized tonic clonic or complex partial seizures.
The drug’s once-a-day dosage enhances patient compliance.
Side Effects: gingival hyperplasia (gum irritation);
swollen lymph glands; rash; excess facial hair growth;
thickening of facial skin; liver inflammation.
Gabitril (tiagabine
hydrochloride): Gabitril is used as an adjunctive treatment
of partial seizures. It increases the activity of gamma
aminobutyric acid (GABA), the major inhibitory neurotransmitter
in the central nervous system.
Side Effects: dizziness; lack of energy; nausea;
tremor; nervousness/irritability; reduced ability to
concentrate.
Lamictal (lamotrigine):
This medication is used to treat patients with complex
partial seizures. If Depakote and Lamictal are used
together, Depakote decreases the rate at which the body
uses Lamictal. This makes the Lamictal level two to
three times higher than if used alone.
Side Effects: dizziness; headache; skin rash; blurred/double
vision.
Mysoline (primidone):
Mysoline is prescribed for patients with complex partial
seizures. Once in the body, it breaks down into pema
(an active anticonvulsant) and Phenobarbital (a barbiturate).
Side Effects: drowsiness and hyperirritability
(due to the Phenobarbital); vertigo (tends to decrease
over time); nausea; impotence; skin rash.
Phenobarbital:
Phenobarbital can be prescribed for patients with
generalized seizures, but it often is used only after
other (AEDs) have been tried.
Side Effects: irritability; hyperactivity; drowsiness;
impotence.
Tegretol (carbamazephine):
This medicine is effective in controlling partial seizures
and primary generalized clonic tonic seizures. Unlike
many other AEDs, Tegretol has little effect on cognitive
or general functioning.
Side Effects: nausea, dizziness, drowsiness, and
unsteadiness when first beginning this medication (these
symptoms usually go away over time; it is helpful to
take Tegretol on a full stomach); headache and double
vision at high doses; aplastic anemia.
Topamax (topiramate):
One of the newer AEDs, Topamax is used as an adjunctive
treatment of complex partial seizures. It can be taken
with or without food, but patients should drink plenty
of fluids while taking Topamax to avoid the formation
of kidney stones.
Side Effects: drowsiness, tingling in the hands
or feet, kidney stones, jerky eye movements.
When Can a Patient Stop Taking an AED?
When people do not have seizures for a long period
of time, understandably, they want to stop taking the
prescribed antiepileptic drug. However, patients should
not stop taking their AED without the permission of
their doctor.
Patients who have been seizure-free for many years;
are taking only one AED; have a normal EEG; and have
no neurological or developmental problems are considered
to be good candidates for AED withdrawal. The decision
rests with the doctor and the patient, and the risk
remains that once the AED is stopped, seizures may re-occur.
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