Antiepileptic Drug [Neurosurgery Wiki]

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====== Antiepileptic Drug ======

===== Goal =====
The goal of [[antiepileptic]] drugs (AEDs) is seizure control (a contentious term, usually taken as reduction of seizure frequency and severity to the point of permitting the patient to live a normal lifestyle without epilepsy-related limitations) with minimal or no drug toxicity. ≈ 75% of epileptics can achieve satisfactory seizure control with medical therapy
((Brodie MJ, Dichter MA. Antiepileptic Drugs. N Engl J
Med. 1996; 334:168–175))

===== Outcome =====

see [[Antiepileptic drug treatment outcome]].


First-line [[treatment]] for [[epilepsy]] is [[antiepileptic drug]] and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. 

Most patients will respond to one or two different medication trials. In up to one third of patients with epilepsy, medications alone will be unable to eliminate seizures, or cause unacceptable adverse effects. In these patients, work up for the feasibility of epilepsy surgery is considered.

Although many patients have seizure control using a single medication, others require multiple medications, resective surgery, neuromodulation devices or dietary therapies.

Elucidating the mechanism of selective regulation of different [[aquaporin]]s (AQPs) and associated regulatory proteins may provide a new therapeutic approach to epilepsy treatment
((Salman MM, Sheilabi MA, Bhattacharyya D, Kitchen P, Conner AC, Bill RM,
Woodroofe MN, Conner MT, Princivalle AP. Transcriptome analysis suggests a role
for the differential expression of cerebral aquaporins and the MAPK signalling
pathway in human temporal lobe epilepsy. Eur J Neurosci. 2017 Jul 17. doi:
10.1111/ejn.13652. [Epub ahead of print] PubMed PMID: 28715131.
)).

Antiepileptic [[drug]]s (AEDs) remain the primary [[treatment]] strategy to suppress [[seizure]] activity, but do not address the underlying neuropathological process. While surgical intervention— such as [[neuromodulation]] or [[resection]]— is an option for some of these patients, many require long-term AEDs for seizure control
((Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365(10):919-926.)).

Conventional antiepileptic drugs suppress the excessive firing of neurons during seizures. In drug-resistant patients, treatment failure indicates an alternative important epileptogenic trigger.

Anticonvulsants (also commonly known as antiepileptic drugs or as antiseizure drugs) are a diverse group of pharmaceuticals used in the treatment of epileptic [[seizure]]s. 

Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and for the treatment of neuropathic pain. 

Anticonvulsants suppress the rapid and excessive firing of neurons during seizures. Anticonvulsants also prevent the spread of the seizure within the brain. Some investigators have observed that anticonvulsants themselves may cause reduced IQ in children.

However these adverse effects must be balanced against the significant risk epileptic seizures pose to children and the distinct possibility of death and devastating neurological sequelae secondary to seizures. Anticonvulsants are more accurately called antiepileptic drugs (abbreviated "AEDs"), and are often referred to as antiseizure drugs because they provide symptomatic treatment only and have not been demonstrated to alter the course of epilepsy.



There is increasing emphasis on untangling the interactive forces of new antiepileptic medications from epilepsy/seizures on the neurophysiological, neuropsychologic and psychiatric/behavioral functioning of individuals with epilepsy. The role of GABA in the pathophysiology of seizures and status epilepticus has led to novel therapy proposals. 

Anti-epileptic drugs (AEDs) are the main form of treatment for people with epilepsy. And up to 70% (7 in 10) people with epilepsy could have their seizures completely controlled with AEDs. There are around 26 AEDs used to treat seizures, and different AEDs work for different seizures. Here we explain what the different AEDs are, what type of seizures or epilepsy they are used for, as well as some essential information about average doses and common side effects.
   
There are three ways you can search for information about AEDs:

by the generic name of the AED
by the brand name of the particular type of AED or
by the type of seizure or seizures you have.

===== Classification =====

[[Antiepileptic drug classification]].

===== Indications =====


Absence seizures (including typical and atypical absences):
Acetazolamide | Clonazepam | Ethosuximide | Lamotrigine | Sodium valproate
 
Atonic seizures:
Phenobarbital | Phenytoin | Primidone | Sodium valproate 
 
Catamenial seizures (menstrual-related):
Acetazolamide | Clobazam
 
Cluster seizures:
Clobazam 
 
Episodic disorders:
Acetazolamide
 
Dravet syndrome (severe myoclonic epilepsy in infancy or SMEI):
Stiripentol 
 
Focal (partial) seizures:
Acetazolamide | Carbamazepine | Clobazam | Clonazepam | Eslicarbazepine acetate | Gabapentin | Lacosamide | Lamotrigine | Levetiracetam | Oxcarbazepine | [[Perampanel]] | Phenobarbital | Phenytoin | Pregabalin | Primidone | Retigabine | Sodium valproate | Tiagabine | Topiramate | Vigabatrin | Zonisamide 
 
Focal (partial) seizures with secondary generalisation:
Gabapentin | Lacosamide | Levetiracetam | [[Perampanel]] | Phenobarbital | Phenytoin | Pregabalin | Primidone | Retigabine | Sodium valproate | Tiagabine | Topiramate | Vigabatrin | Zonisamide 
 
Focal seizures with secondary generalised tonic clonic seizures:
Carbamazepine | Eslicarbazepine acetate | Lamotrigine | Oxcarbazepine
 
Infantile spasms:
Nitrazepam | Sodium valproate | Vigabatrin 
 
Juvenile Myoclonic Epilepsy (seizures related to):
Levetiracetam 
 
Lennox-Gastaut syndrome (seizures related to):
Lamotrigine | Rufinamide | Topiramate 
 
Menstrual-related (catamenial seizures):
See: Catamenial seizures (above)
 
Myoclonic seizures:
Clonazepam | Ethosuximide | Phenobarbital | Phenytoin | Primidone | Piracetam | Sodium valproate 
 
Myoclonic seizures in Juvenile Myoclonic Epilepsy:
See: Juvenile Myoclonic Epilepsy (above)
  
Tonic seizures:
Phenobarbital | Phenytoin | Primidone | Sodium valproate 
 
Tonic clonic seizures:
Acetazolamide | Carbamazepine | Clobazam | Clonazepam | Eslicarbazepine acetate | Lamotrigine | Phenobarbital | Phenytoin | Primidone | Sodium valproate | Topiramate
 
Tonic clonic seizures in severe myoclonic epilepsy in infancy (SMEI or Dravet syndrome):
See: Dravet syndrome (above)
 
West Syndrome with Tuberous Sclerosis:
Vigabatrin

Anticonvulsants have been shown to be effective in managing [[pain]], though high systemic levels and subsequent side effects limit its widespread usage. 

====Prophylactic anticonvulsants in brain tumors====
see [[Antiepileptic Drug prophylaxis in brain tumor]]
----
Patients with [[epilepsy]] are frequently required to take [[antiepileptic drug]]s (AEDs) for a long period of time. Many studies have shown that AEDs have a negative influence on endocrine function including the [[thyroid gland]].

Female patients with epilepsy and an older age, AED polytherapy, and [[carbamazepine]] treatment had a higher risk of low fT4. Thyroid function in these patients should be monitored closely.
((Shih FY, Chuang YC, Chuang MJ, Lu YT, Tsai WC, Fu TY, Tsai MH. Effects of
antiepileptic drugs on thyroid hormone function in epilepsy patients. Seizure.
2017 Mar 19;48:7-10. doi: 10.1016/j.seizure.2017.03.011. [Epub ahead of print]
PubMed PMID: 28364656.
)).

==== Antiepileptic Drug prophylaxis for traumatic brain injury ====
[[Antiepileptic Drug prophylaxis for traumatic brain injury]]

===== Valproate =====
[[Valproate]]

===== Levetiracetam =====
[[Levetiracetam]]

===== Lamotrigine =====
[[Lamotrigine]]

===== Antiepileptic Drug Withdrawal =====
[[Antiepileptic Drug Withdrawal]]