Hello gaild,
I have compiled a list of the newest anti-epileptic drugs, with
information and side effects on each. Studies on effectiveness are not
available on each drug, but I have included a user rating for
effectiveness, where one was available. Medications can react
differently in each patient?what is effective in one patient may prove
less so in another. Other medications or conditions can cause the
drugs to be more or less effective as well.
Overall:
========
See a list of the newest drugs on slide 6 of this Medscape site of
?Recent Advances in the Management of Epilepsy (Live Web Conference)
Presenters: Gregory K. Bergey, MD, and Gregory L. Holmes, MD Release
Date: January 14, 2004
(If you don?t have a membership to this site, you can sign up quickly,
and it is free)
http://www.medscape.com/viewarticle/467866_1
Slide 18 has a good comparison of the different drugs and their side effects.
http://www.medscape.com/viewarticle/467866_11
Newest Drugs listed are:
(Drugs released in the past decade)
For generalized seizures:
1)Keppra (levetiracetam)
2)Lamictal (Lamotrigine)
3)Topiramate (Topamax)
For partial seizures
4)Felbatol (Felbamate)
5)Neurontin (Gabapentin)
6)Keppra (levetiracetam)
7)Lamictal (Lamotrigine)
8)Topiramate (Topamax)
9)Trileptal (Oxcarbazepine) + Carbamazepine
10) Gabitril (Tiagabine)
11) Zonisamide
All seizure medications will cause side effects of some kind. The
effects can be minimized and controlled, in most cases, by finding the
drug that works best for each person, and with careful monitoring.
Your physician will decide which medication is best for your
individual condition.
I?ll start with the old standby, Dilantin.
Dilantin (phenytoin):
These are the most common side effects of dilantin, and most resolve
quickly over a few days. If these side effects continue beyond several
days, a call to your physician will
be necessary.
·jerking movements of the eyes
·decreased coordination
·shaking of the hands
·slowed thinking and movement
·memory problems
·slurred speech
·poor concentration
After taking dilantin over a long period of time, the following side
effects may manifest:
·overgrowth of the gums
·excessive hair on the face or body
·acne
·coarseness of facial features
Overgrowth of the gums (gingival hyperplasia) is seen more frequently
in children, and can often be controlled with rigorous brushing and
flossing.
http://epilepsyflat.zoomedia.com/medications/b_dilantin_side.html
The above site is written in frames, meaning I can?t post a separate
link to each page. Click on the menu in the right hand column to
navigate the side effect menu.
From the Dilantin Capsules package insert:
?1. Drugs which may increase phenytoin serum levels include: acute
alcohol intake, amiodarone, chloramphenicol, chlordiazepoxide,
diazepam, dicumarol, disulfiram, estrogens, H2-antagonists, halothane,
isoniazid, methylphenidate, phenothiazines, phenylbutazone,
salicylates, succinimides, sulfonamides, tolbutamide, trazodone.
2. Drugs which may decrease phenytoin levels include: carbamazepine,
chronic alcohol abuse, reserpine, and sucralfate. Moban® brand of
molindone hydrochloride contains calcium ions which interfere with the
absorption of phenytoin. Ingestion times of phenytoin and antacid
preparations containing calcium should be staggered in patients with
low serum phenytoin levels to prevent absorption problems.
3. Drugs which may either increase or decrease phenytoin serum levels
include: phenobarbital, sodium valproate, and valproic acid.
Similarly, the effect of phenytoin on phenobarbital, valproic acid,
and sodium valproate serum levels is unpredictable.
4. Although not a true drug interaction, tricyclic antidepressants may
precipitate seizures insusceptible patients and phenytoin dosage may
need to be adjusted.
5. Drugs whose efficacy is impaired by phenytoin include: corticosteroids, coumarin
anticoagulants, digitoxin, doxycycline, estrogens, furosemide, oral
contraceptives, quinidine, rifampin, theophylline, vitamin D.
Warnings are found on page 3, and adverse reactions begin on page 6 of
this document. (Because of copyright laws, I may not reproduce the
entire document here!)
http://www.pfizer.com/download/uspi_dilantin_kapseals.pdf
?Phenytoin has the potential to cause liver toxicity as well as some
serious forms of skin rash. More commonly, however, it causes gum
growth, increased facial hair, and bone mineral loss. Needless to say
it is not the ideal cosmetic medication. When to dose gets too high,
the most common complaint is walking like one is drunk or being
dizzy.?
http://www.loftusmd.com/Articles/AED/dilantin.html
User ratings for effectiveness 7.7
http://remedyfind.com/rem.asp?ID=4168
1)Keppra
One of the newest AEDs (Anti-epileptic drugs), Keppra seems to have
the fewest side effects.
?For epilepsy, Keppra® is effective for partial-onset seizures. It
lacks any of the typical serious side effects of the older AEDs
involving the liver or bone marrow. It does not have any known
interaction with any of the other AEDs or other medications.?
http://www.loftusmd.com/Articles/AED/keppra.html
http://epilepsyflat.zoomedia.com/medications/b_keppra_intro.html
http://www.keppra.com/usindex.asp
?Keppra (levetiracetam) as monotherapy appears to provide good seizure
control in elderly patients with epilepsy, according to results of a
study presented here December 9th at the American Epilepsy Society
Annual Meeting.
According to researchers from University Hospitals, Cleveland, Ohio,
United States, Keppra monotherapy achieved a 70% reduction in seizure
frequency in patients who switched from other therapies.
In addition, those patients also appeared to gain improved cognition
when switched to Keppra, an important benefit considering that elderly
persons with epilepsy are often on multiple medications for comorbid
conditions, said lead researchers Mary Ann Werz, MD, PhD, director,
Comprehensive Epilepsy Program, University Hospitals.?
http://www.pslgroup.com/dg/24039e.htm
?Side Effects - Generally well tolerated. Dizziness, somnolence, or
asthenia (lack or loss of strength) may occur in some patients.
Slightly decreased red blood and white blood cell counts are
occasionally seen.
Interactions - No known interactions with other drugs. ?
http://epilepsyontario.org/client/eo/EOWeb.nsf/web/levetir
?This is the list of side-effects that Keppra can cause. You may not
get any of these side-effects, but you may get some. While you are
taking Keppra, these are the things you should watch out for:
· Accidental injury
· Aggression
· Anger
· Anxiety
· Appetite - decrease or loss of appetite
· Behaviour changes
· Bleeding - unexplained bleeding
· Bruising - unexplained bruising
· Confusion
· Coordination - difficulty with coordination
· Depression
· Diarrhoea
· Dizziness
· Double vision
· Emotional instability
· Hallucinations
· Headache
· Hostility
· Indigestion
· Insomnia
· Irritability
· Memory - difficulty with memory or thinking
· Nausea
· Nervousness
· Psychosis
· Rash or rashes
· Seizures - loss of seizure control or change in the character of the seizure
· Sleepiness
· Tiredness
· Tremor
· Vertigo
· Weakness?
http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=9985
http://medguides.medicines.org.uk/
Read users ratings on effectiveness. Average rating was 5.5, on a scale of 1-10
http://remedyfind.com/rem.asp?ID=4169
2)Lamictal
A newer broad spectrum AED, used for partial and general seizures.
http://epilepsyflat.zoomedia.com/medications/b_lamictal_intro.html
?Lamictal: The next medication chosen to treat JME is frequently
Lamictal (lamotrigine). It can be used either in combination with
Depakote or by itself and is often effective for myoclonus, absences,
and tonic-clonic seizures.
There has been no randomized, controlled trial to compare the
effectiveness of Lamictal with Depakote, but doctors who see many
patients with JME generally report that Lamictal is not as helpful for
the tonic-clonic seizures as Depakote. In fact, it has not been
specifically approved by the U.S. Food and Drug Administration (FDA)
for the treatment of JME because the necessary types of studies have
not been performed.?
http://www.epilepsy.com/articles/ar_1068588110.html
?Lamictal® has one uncommon, serious potential side effect of skin
rash which seems to be most closely related with the rate of increase
of the medication. This side effect dictates that the rate of
medication be raised slowly over time. It can take a few months to get
a patient on their final dose of Lamictal. In addition, Lamictal® has
significant drug interactions with many other AEDs and, therefore, its
rate of administration must be individualized based upon the type of
medication the patient is already taking. I am aware of one case
report where Lamictal® apparently caused severe bone marrow
suppression.?
http://www.loftusmd.com/Articles/AED/lamictal.html
?This is the list of side-effects that Lamictal can cause. You may not
get any of these side-effects, but you may get some. While you are
taking Lamictal, these are the things you should watch out for:
· Aggression
· Agitation
· Balance problems
· Bleeding - unexplained bleeding
· Bruising - unexplained bruising
· Confusion
· Conjunctivitis
· Coordination - difficulty with coordination
· Diarrhoea
· Disseminated intravascular coagulation
· Dizziness
· Double vision
· Drowsiness
· Facial oedema
· Fever
· Hallucinations
· Headache
· Increase frequency in getting infections
· Insomnia
· Involuntary jerky movements of the eyes
· Irritability
· Liver problems
· Lupus erythematosus type reaction
· Lymphadenopathy
· Movements - unsteady movement
· Nausea
· Parkinson's - worsening of Parkinsonian symptoms in people who have
Parkinson's disease
· Periods - changes in your periods, they may stop or become irregular
· Rash or rashes
· Seizure control - loss of seizure control
· Stevens Johnson syndrome
· Tics
· Tiredness
· Toxic epidermal necrolysis
· Tremor
· Vision - blurred vision
· Vomiting
· Walking difficulty
http://medguides.medicines.org.uk/
Users ratings, effectiveness 6.6
http://remedyfind.com/rem.asp?ID=4161
Package Insert
http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=9985
3)Topiramate
?Topiramate (Topamax) is another of the newer antiepileptic drugs,
which is indicated in children and adults between 2 and 16 years of
age with partial seizures, or primary generalized tonic-clonic
seizures, and in patients 2 years of age and older with Lennox-Gastaut
syndrome. It's a drug, therefore, that would fall within the
broad-spectrum range, because it's good for both partial seizures and
generalized seizures. And if used in the right manner, is reasonably
well tolerated. One of the problems that we came up with, that we
discovered with topiramate when we first started using it, is people
tended to dose this drug pretty high. And we started seeing a lot of
side effects, both in children and adults with troubled thinking,
speech difficulties, and some of these patients even developed
stuttering. There have been rare cases of glaucoma with topiramate --
it's a painful glaucoma, but it's reversible.?
http://www.medscape.com/viewarticle/467866_8
http://epilepsyflat.zoomedia.com/medications/b_topamax_intro.html
?In particular, tell your doctor or pharmacist if you are taking any
of the following:
· other medicines for epilepsy, such as phenytoin or carbamazepine
· digoxin (used to treat heart disease)
· oral contraceptives (the pill)
· alcohol or any medicine which slows your reactions. This may include
medicines to help you sleep or relieve pain, antidepressants,
tranquillisers or antihistamines which can make you drowsy.
There may also be some other medicines that may cause problems if used
together with TOPAMAX. So, make a point of telling your doctor or
pharmacist which medicines you are taking at the moment, and before
you start taking any new medicines. They will tell you which medicines
should not be taken or what other measures (for example, a change of
dose) are necessary.?
Tell your doctor if you notice any of the following:
· unusual tiredness, drowsiness, weakness, dizziness
· decrease in appetite or weight loss
· headache
· unsteady or abnormal way of walking
· tingling and numbness in fingers and toes
· nausea, diarrhoea, increased saliva, altered sense of taste, stomach pain
· difficulty in controlling emotions.
Tell your doctor immediately if you notice any of the following as you
may need urgent medical care:
· difficulty with concentration or attention; confusion
· difficulty with memory and/or thinking
· depression, mood problems, abnormal thoughts
· agitation, unusual nervousness
· co-ordination problems, tremor or slow reaction
· speech or language problems
· effects on eyes or vision (e.g. double vision)
· frequent infections with symptoms such as fever, severe chills, sore
throat or mouth ulcers.
Tell your doctor immediately or go to Accident and Emergency at your
nearest hospital if any of the following happen:
· you have an allergic reaction to TOPAMAX
· you have blood in your urine or severe lower back pain which spreads
towards the groin area
· you have sudden severe pain in the chest, arms or legs.
Other side effects not listed above may also occur in some people. Do
not hesitate to report any other side effects to your doctor or
pharmacist.?
http://www.inhousepharmacy.com/neurological/topamax-information-patients.html
?As an AED, Topamax has been shown to be highly effective.? And
?Topamax (topiramate) is one of the newly approved anti-epileptic
drugs (AED) approved by the FDA in the last 10 years. It is
considered a broad spectrum AED because it works to prevent both
partial onset and generalized seizures?
and ?Topamax lacks many of the more serious side effects seen with the
older AEDs including a lack of known problems with bone marrow and an
extremely small incidence of liver abnormalities apparently confined
to patients with prior liver abnormalities. It does have a fairly
common side effect of kidney stones (between 1-2%). It is also one of
only three AEDs that have a statistically proven propensity to lose
weight (Zonegran and Felbamate are the others). Other side effects
include a change in taste, particularly with carbonated drinks,
tingling in the extremities, and at times interference with mental
function.?
http://www.loftusmd.com/Articles/AED/topiramate.html
User ratings 6.5 for effectiveness
http://remedyfind.com/rem.asp?ID=4164
?Topiramate is very effective in reducing partial seizures in most
people who take it.?
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=support/hw110609
It may also help control generalized tonic-clonic seizures and
seizures caused by Lennox-Gastaut syndrome.1
4) Felbamate
Felbamate is not available in Canada.
?As I'll mention in a few minutes, we are avoiding felbamate because
of the risks of aplastic anemia and hepatotoxicity.?
http://www.medscape.com/viewarticle/467866_9
http://epilepsyflat.zoomedia.com/medications/b_felbatol_intro.html
?Adverse events Common Adult Monotherapy: Insomnia, Fatigue, Headache,
Vomiting (GI)Add-On therapy; Fatigue, Headache, Somnolence, Dizziness,
Nausea, Vomiting
Children Add-on therapy: Fever, Fatigue, Somnolence, Insomnia, Nervousness
Serious Aplastic anemia, hepatic failure?
http://www.aesnet.org/Visitors/PatientsPractice/aed/aedtable.cfm?drug=Felbamate
?Felbamate and lamotrigine have the potential of significant side
effects and should be prescribed by physicians experienced in managing
patients with complicated epilepsy.?
http://www.aafp.org/afp/980201ap/curry.html
?Common side effects of felbamate include:
· Nausea, vomiting, and indigestion.
· Headache.
· Weight loss.
· Insomnia (sleep problems).
Most of these problems tend to go away once the body adjusts to the
drug. Weight loss and insomnia are common long-term problems,
however.?
http://www.questdiagnostics.com/kbase/topic/detail/drug/hw110487/detail.htm
?There was concern about felbamate because some persons had developed
aplastic anemia (bone marrow failure) while taking felbamate. In most
cases, this occurred within the first year of treatment. There have
also been reports of liver failure on this medication. An FDA advisory
panel recommended its continued availability to treat persons with
severe epilepsy, and thus it continues to be available. However, there
are now recommendations to have blood counts and liver studies drawn
regularly to monitor for this.?
http://www.siumed.edu/neuro/epilepsy/QNA/QNAframes/felbamatejs.html
?Side Effects - Rare but life-threatening adverse effects occur, such
as aplastic anemia and liver toxicity. Therefore, use is restricted to
highly refractory epilepsy. Dose-dependent adverse effects include
nausea, anorexia, weight loss, insomnia, headache.
Precautions - Must carefully monitor blood counts and liver function
for at least the first year of use. Increase vigilance if patient has
an autoimmune disease, is older than 12-years-old, female, and has had
adverse reactions to other antiepileptic drugs.?
http://epilepsyontario.org/client/eo/EOWeb.nsf/web/felbamat
?Common side effects of felbamate include:
· Nausea, vomiting, and indigestion.
· Headache.
· Weight loss.
· Insomnia (sleep problems).
Most of these problems tend to go away once the body adjusts to the
drug. Weight loss and insomnia are common long-term problems,
however.?
?Felbamate controls partial seizures in adults very well. In children
with Lennox-Gastaut syndrome, felbamate may reduce how often seizures
occur, but it may not make the child seizure-free. However, it has
made some children more alert and improved their quality of life.?
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=hw110487
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=support/hw110501
5)Neurontin (Gabapentin)
?About 20 to 30 out of 100 people who have added gabapentin to their
drug therapy have reduced their seizures by more than half.1
Gabapentin is not as effective as other new epilepsy drugs, but it
appears to be less toxic?
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=support/hw110535
?Side Effects - Generally well tolerated. May cause headache, ataxia,
fatigue, nausea, or somnolence in some patients.
Precautions - Before using this gabapentin, inform your doctor if you
are taking other prescription or non-prescription medications, have
multiple seizures, are pregnant or breast feeding, drink alcohol, or
have kidney disease. If your seizures worsen while taking gabapentin,
or if you experience a severe or unusual allergic reaction, call your
doctor immediately. If your seizures are uncontrolled by this drug, do
not drive or operate dangerous machinery until your dosage no longer
poses a threat to you.?
http://epilepsyontario.org/client/eo/EOWeb.nsf/web/gabapent
http://epilepsyflat.zoomedia.com/medications/b_neurontin_intro.html
What side effects may occur?
?Side effects cannot be anticipated. If any develop or change in
intensity, inform your doctor as soon as possible. Because Neurontin
is used with other antiseizure drugs, it may not be possible to
determine whether a side effect is due to Neurontin alone. Only your
doctor can determine if it is safe for you to continue taking
Neurontin.
·More common side effects may include:
Blurred, dimmed, or double vision, bronchitis (in children),
dizziness, drowsiness, fatigue, fever (in children), involuntary eye
movement, itchy, runny nose, lack of muscular coordination, nausea,
tremor, viral infection (in children), vomiting, weight increase (in
children)
·Less common or rare side effects may include:
Abnormal coordination, abnormal dreams, abnormal thinking, agitation,
allergy, altered reflexes, anemia, angina pectoris (crushing chest
pain), anxiety, apathy, arthritis, back pain, behavioral or
psychological problems, bladder problems, bleeding gums, bloody
stools, bruising, cataracts, chill, conjunctivitis (pinkeye),
constipation, cough, cysts, decreased sensitivity to touch,
dehydration, depression, difficult or labored breathing, dry eyes, dry
mouth or throat, dry or scaly skin, ear problems, exaggerated feeling
of well-being, excessive body hair, eye pain or disorder, fainting,
feeling "high," "fever" blisters on lips and mouth, fluid retention,
fracture, gas, general feeling of illness, hair loss, hallucination,
headache, heart murmur, heartburn, hemorrhoids, hepatitis, high blood
pressure, hoarseness, hostility, hyperactivity, increased appetite,
increased salivation, increased sweating, indigestion, inflammation of
the mouth, gums, or tongue, inflammation of the stomach and intestinal
lining, irregular heartbeat, itching, joint pain, stiffness, or
swelling, liver enlargement, loss of appetite, loss of bowel control,
loss of memory, low blood pressure, menstrual problems, migraines,
mononucleosis, mouth sores, muscle pain or weakness, nervousness,
nosebleeds, paralysis, pneumonia, respiratory infections, sexual
problems, shortness of breath, skin disorders, sleepwalking, sore
throat, speech difficulties, stupor, swelling of the face, taste loss,
tendinitis, thirst, tingling or pins and needles, twitching, unstable
emotions, vaginal hemorrhage, vertigo, weight increase or decrease?
http://www.inhousepharmacy.com/neurological/neurontin.html
?As an anti-epileptic, the medication is effective only for
partial-onset seizures. The medication has gained widespread use
because of its tremendous safety profile and relative lack of
significant serious side effects. To my knowledge, there have not been
any reports of liver, bone marrow, or other major side effects
associated with this medication. One aspect enhancing its safety is
the human body's limited ability to absorb the medication. At doses
above 4800 mg or so, many patients stop absorbing the additional dose.
Even without this feature the medication is very safe. Neurontin also
lacks any known drug interactions with other AEDs making the
medication very easy to use. Guidelines by the American Academy of
Neurology supports its use for new onset partial seizures and its use
as add-on therapy in children and adults.?
http://www.loftusmd.com/Articles/AED/neurontin.html
?If it was all marketing, then neurontin would have taken over the
seizure market. It has not because it is a 3 times daily drug which
therefore has compliance issues. It also causes weight gain.?
http://www.loftusmd.com/Articles/legal/neurontinlegal.html
?Possible Neurontin Side Effects: SIDE EFFECTS that may occur while
taking this medicine include tiredness, drowsiness, dizziness, tremor,
back pain, dry mouth, constipation, increased appetite, or an upset
stomach. If they continue or are bothersome, check with your doctor.
CHECK WITH YOUR DOCTOR AS SOON AS POSSIBLE if you experience decreased
coordination, changes in vision (double or blurred vision), back and
forth eye movements, persistent sore throat or fever, swelling of
ankles, mental or mood changes, memory loss, or trouble speaking. If
you notice other effects not listed above, contact your doctor, nurse,
or pharmacist.?
http://www.peopleschoicerx.com/neurontin-side-effects.htm
6)See #1
7)See #2
8)See #3
9)Trileptal (oxcarbazepine)
?One is the oxcarbazepine, which is a derivative of carbamazepine, but
it's important to remember that it's a different drug. If you look at
how this drug works on sodium channels, it's a sodium blocker; it
really works differently and it has the response... different than
with carbamazepine. And in fact some patients that have failed on
carbamazepine, when you add oxcarbazepine, actually do quite nicely.
So just because someone hasn't done well on carbamazepine does not
mean you cannot use oxcarbazepine. It seems to have fewer side
effects, and it does not have what we call the black-box warning.
There are no indications that this will cause aplastic anemia or
hepatotoxicity. So you really do not have to draw blood studies,
complications on the drug.?
http://www.medscape.com/viewarticle/467866_7
?Trileptal has now been in use since 1990, and it appears to be very
safe. In the earliest tests, people who took it as their only
medication or as an add-on to another seizure medicine were only
slightly more likely to quit because of side effects than people who
took a placebo (a pill with no active medicine) instead.
Some side effects of Trileptal that have been reported include:
·dizziness
·headache
·tiredness
·drowsiness
·double vision
·stomach upset
·loss of coordination
If you notice any of these problems, call the doctor's office.
Sometimes the doctor can help by changing the amount of Trileptal you
take or how you take it. Don't stop taking Trileptal or change the
amount you take without the doctor's guidance.?
http://epilepsyflat.zoomedia.com/medications/b_trileptal_intro.html
Carbamazapine
http://epilepsyflat.zoomedia.com/medications/b_carbamazepine_intro.html
http://www.epilepsy.com/medications/b_tegretol_intro.html
User ratings 7.3 for effectiveness
http://remedyfind.com/rem.asp?ID=4163
10)Gabitril (Tiagbine)
?This is the list of side-effects that Gabitril can cause. You may not
get any of these side-effects, but you may get some. While you are
taking Gabitril, these are the things you should watch out for:
·Accidental injury
·Behaviour - risk of recurrence of severe behaviour problems
·Bruising
·Concentration - poor concentration
·Confusion
·Delusions
·Depression
·Diarrhoea
·Dizziness
·Emotional instability
·Hallucinations
·Increase frequency in getting infections
·Nervousness
·Non-convulsive status epilepticus
·Psychosis
·Sleepiness
·Speech - slowing or slurring of speech
·Tiredness
·Tremor
·Visual field defect
http://medguides.medicines.org.uk/displaypage.aspx?t=medicine&i=41
?Many people who take Gabitril (tiagabine) don't report any unwanted
side effects. Those who experience undesirable effects most often
complain of:
· dizziness
· tiredness
· nervousness
· sleepiness
· difficulty concentrating
· tremor
Be careful when you first start taking Gabitril. Make sure you don't
have a problem with sleepiness or dizziness when driving or doing
anything else that might be dangerous.
Some other side effects mentioned even less often were:
· nausea
· vomiting
· diarrhea
· weakness (for example, sometimes people say that their knees buckled)
· irritability
· confusion
http://epilepsyflat.zoomedia.com/medications/b_gabitril_intro.html
?When added to treatment with another antiepileptic drug, tiagabine is
sometimes effective in reducing partial seizures in people who have
had trouble controlling their seizures with other drug treatment
(medically refractory epilepsy).?
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=support/hw110640
11)Zonisamide
Zonisamide is one of the newest anti-epileptic drugs, and intended for
partial seizures. One benefit is the once-a-day dosing. Not available
in Canada.
?Zonisamide -- as far as it has a very long half-life, even in
children, we can give this drug once a day, which is a great
advantage, but there had been some reports of hypothermia and
decreased sweating, and this is a sulfa-derivative drug, so you have
to be careful if the patient has a rash.?
http://www.medscape.com/viewarticle/467866_11
?It is considered effective in partial onset seizures. It does not
appear to cause any bone marrow problems. Its incidence of liver
toxicity is much lower than the older AEDs. It can cause renal stones.
It is in the sulfa family of drugs and therefore should not be used by
patients allergic to sulfa drugs. The medication should be
discontinued in patients who develop a rash. The medication does not
interfere with birth control pills. Its safety in pregnancy is not
known. There are drug interactions with other AEDs.?
http://www.loftusmd.com/Articles/AED/zonegran.html
?Side Effects
The most common side effects of zonisamide include:
· Loss of appetite and weight loss.
· Nausea.
· Headache.
· Agitation, irritability, decreased concentration, or confusion.
http://www.questdiagnostics.com/kbase/topic/detail/drug/tf2924/detail.htm
?Side Effects - Side effects are normally transient and self-limited.
Somnolence, dizziness, gastrointestinal upset (anorexia, nausea,
diarrhea) or rash may occur.
Precautions - Slow titration may decrease the incidence of side effects.
Interactions
o Blood levels decreased by phenobarbital, phenytoin, carbamazepine.
o Blood levels not changed by valproate, felbamate, gabapentin,
lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine.
http://epilepsyontario.org/client/eo/EOWeb.nsf/web/zonis
?Very few people have serious reactions to Zonegran. If you take it,
you should be aware of them, however, so you and your family can
recognize them. Here's a list of warning signs that may be the start
of one of these problems:
If you notice any of these symptoms, call your doctor right away:
· Rash
· Fever, sore throat, sores in your mouth, or easy bruising (could
mean a blood problem)
· Sudden back pain, pain in the stomach area, pain when urinating, or
bloody or dark urine (could mean a kidney stone)
· Decreased sweating or rise in body temperature, especially for a child
· Depression
· Thoughts that are unusual for you
If you notice mood changes with Zonegran, speak to your doctor or
nurse. A slight reduction in the dosage may improve your frame of
mind. If you had a history of depression before starting Zonegran,
your doctor may consider other treatments such as antidepressants or
referral to a counselor or psychiatrist?
http://epilepsyflat.zoomedia.com/medications/b_zonegran_intro.html
Other AEDs:
===========
Epilim(Sodium valproate)
? This medicine may cause blood, liver or pancreatic disorders. You
should have blood tests to monitor your liver function and blood cell
count before you start treatment. Your liver function should be
monitored for the first six months of treatment, and your blood cell
count should be checked before any surgery. Tell your doctor
immediately if you experience any of the following symptoms during
treatment: lack of appetite and energy, weakness, drowsiness, nausea,
vomiting, abdominal pain, swelling of ankles or hands, yellowing of
the skin and eyes (jaundice), unusual bruising or bleeding.
· People with diabetes should be aware that Epilim syrup contains
sucrose, and that sodium valproate may cause false positive results in
urine tests for ketones.
· This medicine can cause some people to put on weight. Talk to your
doctor about this before you start treatment so that you can discuss
strategies, such as diet and exercise, for minimising any weight gain.
· This medicine may cause drowsiness, especially if it is taken with
other antiepileptic medicines, or with benzodiazepines such as
lorazepam. This may affect your ability to drive or operate
machinary.?
http://www.netdoctor.co.uk/medicines/100000936.html
?Do not be alarmed by this list of possible side effects. You may not
experience any of them.
Tell your doctor or pharmacist as soon as possible if you do not feel
well while you are being treated with Epilim.
Epilim helps most people with epilepsy or mania, but it may have
unwanted side effects in a few people. All medicines can have side
effects. Sometimes they are serious, most of the time they are not.
You may need medical treatment if you get some of the side effects.
Tell your doctor or pharmacist if you notice any of the following and
they worry you:
·nausea or vomiting in adults
·abdominal cramps
·changes in appetite
·changes in your weight
·diarrhoea
·headache
·tremor
·unsteadiness when walking, dizziness or light-headedness
·hair loss
·feeling tired or drowsy.
These are the more common side effects of Epilim. Mostly these are
mild and short-lived.
·more frequent or more severe seizures (fits)
·blood clotting problems
·spontaneous bruising or bleeding
·rashes
·signs of liver problems such as vomiting, loss of appetite, generally
feeling unwell, tiredness, yellowing of the skin and/or eyes, dark
urine or blood in urine, pain in the abdomen
·swelling of the feet and legs, weight increase due to fluid build up
·severe upper stomach pain, often with nausea and vomiting.
These are serious side effects. You may need urgent medical attention.
http://www.medsafe.govt.nz/consumers/cmi/e/EpilimInj.htm
http://137.172.248.46/treatmen.htm#EPILIM
Ethosuxamide (Zarontin)
?Many people who take Zarontin don't have any trouble with side
effects. The most common complaints (usually not too severe) are
problems like upset stomach, loss of appetite, or diarrhea. These
problems are usually mild and often they go away by themselves. If
they are really bothersome, call the doctor. Usually reducing the
amount of Zarontin or taking it with meals will help, but don't stop
taking Zarontin or change the way it's taken unless the doctor says
it's OK to do that.A few people become sleepy or dizzy when they take
Zarontin, so those who have just started taking it should be careful
during activities that might be dangerous, until they know how it
affects them.?
http://www.epilepsy.com/medications/b_zarontin_intro.html
?Ethosuximide is extremely effective in preventing absence seizures in
children and adults.?
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=support/hw110329
?Ethosuximide may cause severe stomach problems, including:
· Nausea and vomiting.
· Stomach cramps.
· Loss of appetite.
It may also cause headache, mild drowsiness, dizziness, and hiccups.?
http://yalenewhavenhealth.org/library/healthguide/en-us/illnessconditions/topic.asp?hwid=support/hw110331
Clonazepam (Klonopin)
?Klonopin (clonazepam) belongs to a class of medications called
benzodiazepines, which lower brain activity. As a result, common
symptoms include:
· tiredness
· dizziness
· unsteadiness
· impaired attention and memory
· irritability
· hyperactivity (in children)
· drooling (in children)
· depression (usually in adults)
· nausea
· loss of appetite
Scientific studies show that about half of people treated for seizures
with Klonopin experience drowsiness and about 30% have problems with
coordination. In some cases, these problems diminish with time.
About 25% have behavior problems such as hyperactivity in children.
Problems with thinking and behavior are greater with Klonopin than
with seizure medicines like Tegretol, Dilantin, and Depakote.?
http://www.epilepsy.com/medications/i_klonopin_intro.html
On the horizon is Sabril (vigabatrin), developed in France, back in
1977. It is not yet approved by the US FDA, but it has been used in
other countries for some years.
?Unfortunately, as many as 25% of patients who take it for a long time
suffer damage to the retina of the eye, which limits their field of
vision. Because of this safety issue, the FDA has refused to approve
Sabril, and its use has been restricted in some other countries.?
http://epilepsyflat.zoomedia.com/medications/i_sabril_intro.html
http://medguides.medicines.org.uk/displaypage.aspx?t=medicine&i=47
?Side Effects - Common reactions to clonazepam include drowsiness,
fatigue, ataxia (un-coordinated muscles), irritability, and
behavioural problems. Less common side effects may include an allergic
skin rash.
Precautions - Inform your doctor if you have liver, kidney or
respiratory disease or glaucoma. Pregnant women and those who are
breast feeding should also tell their doctors of this prior to using
this clonazepam. Tolerance may develop after 1-6 months of
administration; some patients cease to respond to it. Caution is
advised in giving this drug to children under 12 years.
Interactions - Inform your doctor if you use alcohol, narcotics,
barbiturates, or any over-the-counter medications. Some combinations
of these may increase sedation.?
http://epilepsyontario.org/client/eo/EOWeb.nsf/web/clonazep
?This is the list of side-effects that Sabril can cause. You may not
get any of these side-effects, but you may get some. While you are
taking Sabril, these are the things you should watch out for:
· Abnormal thoughts
· Aggression
· Agitation
· Angioedema
· Behaviour changes
· Breathing difficulty
· Coma
· Concentration - poor concentration
· Confusion
· Coordination - difficulty with coordination
· Depression
· Dizziness
· Double vision
· Drowsiness
· Excitation
· Headache
· Hepatitis
· Involuntary jerky movements of the eyes
· Irritability
· Leg swelling
· Mania
· Memory - difficulty with memory or thinking
· Nausea
· Nervousness
· Optic atrophy
· Paranoid reaction
· Pins and needles - numbness or tingling in the hands or feet
· Psychosis
· Rash or rashes
· Retinal disorder
· Sedation
· Seizures - loss of seizure control or change in the character of the seizure
· Sleepiness
· Speaking difficulty
· Stupor
· Suicidal tendency
· Tiredness
· Tremor
· Tummy pain
· Urticaria
· Vision - difficulty with vision
· Visual field defect
· Weight gain
· Yellowing of the whites of your eyes or skin
Visual field defect (loss of sight from part of your visual field) may
occur whilst you are taking Sabril. This may be permanent, so it is
important that it is found early. If you notice any changes to your
vision, tell your prescriber immediately. As you may not notice this
side-effect, your prescriber will carry out regular tests on your
vision.?
http://medguides.medicines.org.uk/displaypage.aspx?t=medicine&i=47
=======================
Vagal Nerve Stimulation
=======================
?The VNS is a device about the size of a hockey puck, which is placed
in the chest in a manner similar to a pacemaker for the heart. The
surgeon then wraps its lead wires around the vagus nerve. The vagus
nerve is unique among peripheral nerves of the body in that its nuclei
begin in the brainstem (the lower part of the brain) but its
peripheral nerve traverses a large portion of the body (neck, chest,
and part of the abdomen). Once implanted, the neurologist will
program the VNS to deliver a series of stimulations to the vagus nerve
at various strengths and frequencies.?
And
?The VNS does not work by sensing a seizure. Instead it works by
repetitively stimulating the vagus nerve for a period of time and then
by pausing for a period time. How this achieves an anti-epileptic
effect is unknown but the best explanation this author has heard of is
that the device clearly scrambles some of the synchronous discharges
of the brain.?
http://www.loftusmd.com/Articles/AED/VNS.html
http://serendip.brynmawr.edu/bb/neuro/neuro01/web1/Kahn.html
?There may be risks - there are always risks with any surgery and
anaesthetic, and some people have had temporary problems with a cough
or difficulty swallowing (the Vagus is linked to both these
activities). However, although the Vagus nerve also connects the brain
to the lungs and gastrointestinal tract, stimulation doesn't seem to
affect these organs.
Very good results
The new research showed that VNS reduced the number of seizures by at
least 50% in nearly 2/3 of those children treated. In 1 in 4 children
the rate of seizures was reduced by 90% or more. 18% of children found
no change in their seizures.
Nearly 90% of all the children said that their quality of life was
moderately or markedly improved by the treatment.
The results in adults have not been as good as the improvements with
new anti-epileptic drugs but in children the different treatments seem
more comparable (although of course, the treatment works in many of
those resistant to these drugs.)?
http://www.bbc.co.uk/health/ask_doctor/vagal_nerve_stim.shtml
?The results of surgery are generally good, making it a valid option
for the appropriate candidate. Families, however, should be aware of
some potential surgical complications, the possibility (depending on
the seizure type) that seizures will continue after the surgery, and
that medication may be needed in combination with surgery to obtain
the best seizure control.?
http://www.childbrain.com/seizure7.shtml
The Cyberonics® NeuroCybernetic Prosthesis (NCP®) System. This system
has been called a pacemaker for the brain.
http://w3.ouhsc.edu/neuro/division/cope/vns.htm
Referring to the Medscape slide show: ?I want to point out that vagal
nerve stimulation can be another alternative, and in slide 19, there's
a recent study by Jerry Murphy and his group, looking at 100
consecutive children that came in with pharmacoresistant, or poorly
controlled epilepsy, in which the vagal nerve stimulator was put in.
And you can see that there weren't a huge number of people that became
seizure-free, about 17% there. But, there were nice responses, with
43% having over a 50% reduction in seizure frequency, and 25% having
greater than a 90% reduction. So this vagal nerve stimulator can be
quite helpful, studied mainly in partial seizures, and it's an
alternative if your antiepileptic drugs are not working or if the
patient is having side effect on the medication.?
http://www.medscape.com/viewarticle/467866_12
?Holding a special magnet near the implanted device causes the device
to become active outside of the programmed interval. For people with
warnings (auras) before their seizures, activating the stimulator with
the magnet when the warning occurs may help to stop the seizure. Many
patients without auras also experience improved seizure control,
however.?
http://www.epilepsy.com/epilepsy/vns.html
User ratings for effectiveness 7.1
http://remedyfind.com/rem.asp?ID=4173
If adult, check the medscape slide hsow
http://www.medscape.com/viewarticle/467866_15
Monotherapy combotherapy
vagal nerve stimulation and ketogenic diet
Additional Information:
Ketogenic Diet:
?The ketogenic diet, which is very high in fats and low in
carbohydrates, was first developed almost 80 years ago. It makes the
body burn fat for energy instead of glucose. When carefully monitored
by a medical team familiar with its use, the diet helps two out of
three children who are tried on it and may prevent seizures completely
in one out of three. It is a strict diet, and takes a strong
commitment from the whole family. The ketogenic diet is not a
do-it-yourself diet. It is a serious form of treatment that, like
other therapies for epilepsy, has some side effects that have to be
watched for. More research is being done to learn about the underlying
reasons for the diet's positive effect.?
http://www.epilepsyfoundation.org/answerplace/Medical/treatment/diet/
Ketogenic Diet Information
http://www.stanford.edu/group/ketodiet/
Ketogenic Diet Case Histories
http://www.our-kids.org/Archives/Ketogenic_diet_FAQ.html
Epilepsy treatment ratings, from RemedyFind
http://remedyfind.com/sym.asp?id=86
If the first treatment fails:
http://www.epilepsy.com/101/treat101_fails.html
One drug does not fit all:
?The need to try different medications in order to find the best
combination to prevent seizureswith the fewest possible side
effectssometimes gives families the impression doctors are
"experimenting" with their loved one's care, he notes.
"But this is the normal procedure for new patients until their
seizures are stabilized," Van Hazerbeke says.
"Many times the side effects determine the drugs. Some drugs can make
you gain weight, others have other side effects," says Robert J.
DeLorenzo, M.D., a member of the Medical College of Virginia
Hospitals/Virginia Commonwealth University's Epilepsy Institute and
chairman of the neurology department and neurologistinchief at MCV
Hospitals. "Taking care of epilepsy patients is an art, not just a
science; you need to pick a medication that is clinically a good
choice, with the least side effects for the patient. The new drugs are
primarily addon drugs for adding on [to current medications] to
difficult cases.?
http://www.fda.gov/fdac/features/1999/199_epil.html
Epilepsy drugs in the UK
http://www.epilepsy.org.uk/info/drugslist.html#Carbamazepine
From Epilepsy.com, The Facts About Seizure Dogs
http://www.epilepsy.com/articles/ar_1084289240.html
You can find more information about alternative therapies such as
acupuncture, biofeedback, and herbal remedies here:
http://remedyfind.com/sym.asp?id=86
Epilepsy support site:
http://www.epilepsysupport.org.uk/
I hope this helps you understand AEDs better! I wish you the best of luck!
If any part of my answer is unclear, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible.
Sincerely,
crabcakes
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