General Education About Anti-seizure Medications
Antiepileptic drugs (AEDs) are medications used to control seizures in people with epilepsy. There are many different AEDs, each with its own benefits, potential side effects, and considerations. This guide provides general information about AEDs and explains the most common side effects of levetiracetam, valproate, phenytoin, lacosamide, topiramate, carbamazepine, oxcarbazepine, and lamotrigine.
How Antiepileptic Medications Work
AEDs work by stabilizing electrical activity in the brain to prevent seizures. Different medications target different mechanisms, such as:
• Enhancing inhibitory signals to calm overactive neurons.
• Reducing excitatory signals to prevent excessive neuron firing.
• Stabilizing nerve cell membranes to maintain normal electrical activity.
Levetiracetam (Keppra)
Levetiracetam is a commonly prescribed AED used to treat various types of seizures. It has a favorable side effect profile but can cause mood-related issues.
Common Side Effects:
• Irritability or mood changes
• Fatigue or drowsiness
• Dizziness
• Headache
• Rarely, behavioral issues such as aggression or depression
Valproate (Depakote)
Valproate is effective for generalized seizures and some focal seizures. It also has mood-stabilizing properties but requires careful monitoring.
Common Side Effects:
• Weight gain
• Tremor
• Hair thinning or loss
• Nausea or stomach upset
• Liver function changes (requires monitoring)
• Risk of birth defects if used during pregnancy
Phenytoin (Dilantin)
Phenytoin is one of the oldest AEDs, used primarily for focal and generalized tonic-clonic seizures. It requires regular blood level monitoring.
Common Side Effects:
• Gum overgrowth (gingival hyperplasia)
• Dizziness or balance issues
• Fatigue
• Skin rash (rare but serious)
• Long-term use can lead to bone thinning (osteoporosis)
Lacosamide (Vimpat)
Lacosamide is a newer AED often used for focal seizures. It has a favorable side effect profile but requires monitoring for heart-related effects.
Common Side Effects:
• Dizziness
• Nausea
• Fatigue
• Coordination difficulties
• May cause mild heart rhythm changes (requires monitoring in some cases)
Topiramate (Topamax)
Topiramate is used for focal and generalized seizures and is also prescribed for migraine prevention. It has weight-loss benefits but can affect cognitive function.
Common Side Effects:
• Difficulty with memory or concentration (“brain fog”)
• Tingling in hands and feet
• Weight loss
• Increased risk of kidney stones
• Changes in taste (carbonated drinks may taste different)
Carbamazepine (Tegretol)
Carbamazepine is used for focal seizures and is also effective for neuropathic pain. It requires blood level monitoring.
Common Side Effects:
• Drowsiness or dizziness
• Nausea
• Low sodium levels (hyponatremia)
• Rash (rare but serious; can indicate Stevens-Johnson Syndrome)
• Risk of bone marrow suppression (requires periodic blood tests)
• Multiple drug interactions – consult your doctor before starting new medications
Oxcarbazepine (Trileptal)
Oxcarbazepine is similar to carbamazepine but has a lower risk of serious side effects. It is used mainly for focal seizures.
Common Side Effects:
• Dizziness
• Fatigue
• Nausea
• Hyponatremia (low sodium levels, more common in older adults)
• Less risk of severe rash than carbamazepine
Lamotrigine (Lamictal)
Lamotrigine is used for focal and generalized seizures and is also a mood stabilizer for bipolar disorder.
Common Side Effects:
• Rash (most serious risk; can indicate Stevens-Johnson Syndrome, especially if started too quickly)
• Dizziness
• Nausea
• Headache
• Generally well-tolerated if titrated slowly
General Considerations for Antiepileptic Medications
• Always take AEDs as prescribed and do not stop suddenly without consulting your doctor.
• Regular blood tests may be needed for some AEDs to monitor levels and side effects.
• Many AEDs interact with other medications—inform your doctor about all drugs you are taking.
• Some AEDs require extra precautions in pregnancy due to risks of birth defects.
• If you experience severe side effects, contact your doctor immediately.
Conclusion
Antiepileptic medications are essential for controlling seizures, but they can have side effects. By understanding the common effects of different AEDs, patients can work with their doctors to find the best treatment plan. If you have concerns about your medication, speak with your healthcare provider for guidance.