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3 - Which Antiseizure Medicines Treat Epilepsy and How Do I Pick?

Published online by Cambridge University Press:  28 January 2023

Patrick Landazuri ,
Nuria Lacuey Lecumberri ,
Laura Vilella Bertran ,
Mark Farrenburg  and
Samden Lhatoo
Patrick Landazuri
Affiliation:
University of Kansas Medical Centre
Nuria Lacuey Lecumberri
Affiliation:
University of Texas Health Science Center, Houston
Laura Vilella Bertran
Affiliation:
University of Texas Health Science Center, Houston
Mark Farrenburg
Affiliation:
University of Kansas Medical Centre
Samden Lhatoo
Affiliation:
University of Texas Health Science Center, Houston
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Summary

Antiseizure medicines (ASMs) are medicines that reduce seizure frequency. They work by influencing cellular electrical channels like sodium or neurotransmitters like GABA. They are very effective, with 65% of patients seizure-free within the first three ASMs that they take. Unfortunately, less than 1% of people are seizure-free with ASMs after failing three ASMs. These data inform the definition of drug-resistant epilepsy, which is failing two ASMs. Newer ASMs have not been found to be more effective. Lamotrigine has been shown to be better tolerated compared to several other medications. Divalproex has been specifically shown to be most effective for generalized epilepsy, but has a challenging side effect profile, particularly in women. Side effects can be a cause of poor ASM compliance. Proactively accounting for patient factors like psychiatric comorbidity or renal impairment can lead to better tolerability and thus improved compliance. Monotherapy is typically preferred. Polytherapy can be considered in specific situations as well.

Keywords

ASM (antiseizure medicine)side effectadverse effectdrug leveldoseinteraction
Type
Chapter
Information
Seizure and Epilepsy Care
The Pocket Epileptologist
 , pp. 41 - 56
Publisher: Cambridge University Press
Print publication year: 2023

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