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1 results

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

  • Patrick Landazuri, University of Kansas Medical Centre, Nuria Lacuey Lecumberri, University of Texas Health Science Center, Houston, Laura Vilella Bertran, University of Texas Health Science Center, Houston, Mark Farrenburg, University of Kansas Medical Centre, Samden Lhatoo, University of Texas Health Science Center, Houston
  • Book:
    Seizure and Epilepsy Care
    Published online:
    28 January 2023
    Print publication:
    09 February 2023, pp 41-56

  • 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.