Pills With A Purpose

Antiepileptic drugs can be key to managing epilepsy and preventing seizures. Each drug classification is based on its mechanism of action, which is the specific way a drug interacts with the brain or nervous system to reduce the likelihood of seizures or (hopefully) stop them from happening altogether. There are some commonly prescribed AEDs, but the options and combinations are endless. Most neurologists tend to prescribe the following drugs first: Lamotrigine, also called Lamictal, is used for a wide range of seizure disorders. Gabapentin, also called Neurontin, is used for focal seizures. Levetiracetam, also called Keppra or Spritam, is used for focal, myoclonic, and tonic clonic seizures. A possible side effect of Levetiracetam is Keppra rage, significantly altering moods that can cause uncontrolled anger and aggression (been there; done that…i apologize to anyone in my path). Some studies have shown Vitamin B6 to be helpful in reducing Keppra Rage. Phenytoin, also called Dilantin, is used for complex partial and tonic clonic seizures.It is recommended to have genetic testing before starting this drug as it has been linked to Stevens Johnson Syndrome (SJS). Zonisamide, also called Zonegran or Zonisade, is used for focal seizures and is not a medication to be prescribed alone. Carbamazepine, also known as Tegretol, is used for focal and tonic clonic seizures and also linked to SJS. This medication has lots of interactions, so be sure to check with your doctor/pharmacist before you begin use. Oxcarbazepine, also called Trileptal, is used for focal seizures and known to reduce sodium levels so be sure to have regular bloodwork when taking this drug. Valproic Acid derivatives, commonly Depakote, are used for focal and generalized seizures by raising GABA. Topiramate, also known as Topamax (though I refer to it as “dope”amax for the way it made me feel) is used for focal and generalized seizure by reducing the brain’s electrical signals. Alcohol greatly affects the levels of this drug in the body.  Phenobarbital is a barbiturate for focal and generalized seizures. It slows brain activity and has many interactions. It is one of the oldest AEDs (1912) and not FDA approved because it was on the market prior to 1962 when the FDA began evaluations on drugs. This drug has a high toxicity rate due to its low therapeutic range. Be sure to be closely monitored by your neurologist if you start this drug. Once your neurologist/epileptologist determines the cause of your seizures (kinda hit or miss, honestly), he/she will prescribe medication based on its mechanism of action. Sodium Channel Blockers help prevent excessive neural firing. These drugs block special channels in nerve cells that control sodium flow, calming down overactive nerve signals. They change how abnormal electrical activity affects the brain. This class is some of the most common and best understood anti-epileptic drugs. Drugs in this class include Phenytoin, Carbamazepine, and newer ones like Lamotrigine, Oxcarbazepine, and Lacosamide. Another classification is Calcium Channel Blockers. These drugs reduce calcium influx into neurons. Limiting calcium flowing back into nerve cells helps prevent seizures by calming nerve activity.  Drugs in this class include Ethosuximide, Gabapentin, and Pregabalin. Some more  in the arsenal of possibilities are GABA Enhancers. These drugs restore excitatory-inhibitory balance in the brain by calming nerves. They enhance the effects of gamma-aminobutyric acid (GABA), which act as a natural calming agent in the brain, reducing seizure likelihood. Examples of drugs in this classification are Gabapentin, Cenobamate, Tiagabine, and Ganaxolone. Glutamate Inhibitors are another classification of AEDs that work by inhibiting glutamate receptors. They prevent excessive stimulation or overactivity and reduce excitatory transmission. Topiramate and Lamotrigine are examples of Glutamate Inhibitors. There are also newer AEDs and those with unique mechanisms of action. In the class Pyrrolidine is the drug Levetiracetam (Keppra). This  is used for partial, myoclonic, and tonic clonic seizures. There is a drug in its own category of GABA-related AEDs called Vigabatrin (Sabril), prescribed for infantile spasms and complex partial seizures. This drug has been shown to possibly cause loss of vision (so LOOK out!) It raises GABA levels in the central nervous system, having a calming effect. If you don’t yet have your seizures under control, just know that there is hope. The combinations of medications are endless and with that knowledge there is comfort in knowing that being seizure-free is a real possibility. Continue to ask questions, do your research, and stay positive!