The aim of antiepileptic drugs (AEDs) is to control the seizures. To be more specific, they are not a curative treatment. The AEDs efficiency remains in the capacity of controlling the neuronal hyperexcitability, a characteristic feature of epilepsy.

Nowadays, there are almost 20 antiepileptic different drugs; all of them have proven benefits and also different side effects.

 

Type of drugs

Traditionally there are the so-called classic ADEs, such as the first to appear, and the new AEDs, the type of drugs which have appeared during the last 20 years.

 

1) Classic ADEs: 

• Phenytoin
• Carbamazepine
• Valproate (Valproic acid)
• Phenobarbital
• Primidone
• Ethosuximide. Only used for childhood absences. 
• Felbamate. Only used for the Lennox syndrome, compassionate use under the risk of side effects.
• Benzodiazepines: diazepam, clobazam, clonazepam

 

2) Newer ADEs:

• Gabapentin
• Lamotrigine
• Levetiracetam
• Oxycarbazepine
• Pregabalin
• Rufinamide. Indicated only for the Lennox syndrome
• Tiagabine
• Topiramate
• Vigabatrin.  Only used for childhood seizures (West syndrome)

 

3) Last Generation ADEs:

• Eslicarbazepine
• Perampanel
• Zonisamide

 

Patients who have been diagnosed with epilepsy, neurologists normally prescribe Carbamazepine, Valproate, Levetiracetam, Lamotrigine or Oxycarbazepine, unless this type of epilepsy requires a different treatment (West syndrome, Lennox, etc) In the case of absence seizures, Ethosuximide is prescribed as a primary treatment. 

Deciding which drug should be prescribed and its drug dosage, depends on a vast variety of factors, among which, the type of seizures the patient suffers, the patient lifestyle, the age, and the seizures frequencies.

In a span of 2 to 5 years without crisis, the esteem of a drug dosage reduction can be brought out, as well as with the drug treatment suspension. This decision, however, will always be taken by mutual agreement with the patient.

Given the case that the patient has tried three different types of drugs during a period of 3 years (only one year in the case of children), he/ she will be considered drug-resistant and recommended for an evaluation to undergo epileptic surgery.

 

Side effects

As any other drug, ADEs also have side effects. Thus, it is recommended a thorough following of the drug treatment, mostly during the first years.

Side effects may be minor, like fatigue, dizziness, weight gain. In this case, the doses shall be adjusted until finding the right quantity. However, there might be worse side effects, such as allergic skin reaction, or more general scope (fever, adenopathies, etc). These effects might predispose the patient to suffer depression or psychosis. In this case, the drug treatment would be discarded.

In case of the appearance of these symptoms, the doctor must be warned.