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Table for Drugs of Choice in Specific Seizure Types

[ Click on each name for detail ]

Seizure Type First choice Second choice Other Alternatives
Simple/Complex Partial Seizure 

[Carbamazepine has fewer longer term side effects compare to valproic acid but it has more short side effects. Phenytoin has significant side effects. Lamotrigine has few side effects and is as effective as carbamazepine but 10X more expensive. Gabapentin is effective and safe for the newly diagnosed.]

 

Carbamazepine
  • Atretol
  • Carbatrol
  • Carbagen SR
  • Teril CR
  • Timonil Retard
  • Epitol
  • Tegretol

Phenytoin

  • Dilantin
  • Phenytex
  • Epanutin

MePhenytoin

  • Mesantoin 

FosPhenytoin

  • Cerebyx  

Ethotoin

  • Peganone 

Oxcarbazepine 

  • Trileptal

 

Gabapentin #
  • Neurontin

Valproic Acid

  • Depakene
  • Depakote
  • Alti-/ Dom-/ Med-/ Novo-/ Nu-/Penta-Valproic
  • pms-Valproic Acid
  • Deproic
  • Convulex

Valproate Sodium

  • Depacon
  • Epilim
  • Valpro

Divalproex

  • Epival

Lamotrigine

  • Lamictal
  • LTG

Acetazolamide

  • Diamox
  • Storzolamide
  • Dazamide
  • Acetazolam
  • Diamox Sequels
Phenobarbital
  • Luminal
  • Barbita
  • Solfoton
  • Ancalixir

Primidone

  • Mysoline
  • Myidone
  • Sertan

Tiagabine #

  • Gabitril

Topiramate #

  • Topamax

Clonazepam

  • Klonopin
  • Clonapam
  • Rivotril

Clobazam #

  • Frisium

Felbamate

  • Felbatol
  • FBM

Vigabatrin #

  • Sabril

Levetiracetam #

  • Keppra

Zonisamide #

  • Zonegran
  • Excegran
Primary or Secondary Generalized Tonic-Clonic Seizure (Gland Mal)

[Clonazepam is potentially sedative and long term use is associated with tolerance i.e. a larger dose is require for the same effectiveness. ]

Carbamazepine

Valproic Acid 

Valproate Sodium

Divalproex

Phenytoin 

MePhenytoin

FosPhenytoin

Ethotoin

Lamotrigine

Gabapentin 

Phenobarbital 

Primidone 

Acetazolamide

Topiramate #

Tiagabine #

Clonazepam

Clobazam #

Felbamate

Absence Seizure (Petit Mal) Ethosuximide
  • Zarontin
  • Emeside

Valporic Acid

Lamotrigine

Clonazepam

Phenobarbital

Primidone

Tiagabine #

Topiramate #

Felbamate

Myoclonic Seizure Valproic Acid 

Valproate Sodium

Divalproex

Phenobarbital

Ethosuximide

Primidone

Lamotrigine

Acetazolamide

Clonazepam

Clobazam

Nitrazepam

  • Mogadon
  • Alodorm
Atypical Absence Seizure, Atonic Seizure Valproic Acid

Valproate Sodium

Divalproex

Lamotrigine

Clonazepam

Clorazepate

Acetazolamide

Felbamate

Ethosuximide

Ketogenic Diet

Infantile Spasm Valproic Acid,     Vigabatrin,    Nitrazepam,
Lannox Gastaut Syndrome Valproic Acid,     Topiramate,      Clonazepam,    Felbamate
Unclassified seizures Seizures presenting before the age of 25 and cannot be classified are treated as generalized seizures which rarely occur after the age of 25. Over this age, seizures are treated as partial seizures. As above, carbamazepine is the drug of first choice use in treating partial seizure and sodium valproate is the first choice for treatment of generalized seizure.

        Legends: 

  • Brand names

         # an adjunct to therapy (drug is ineffective by itself but enhance effectiveness of others     when use together)

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Choice of AED in young women

Additional consideration in young women:

  1. Carbamazepine and Phenytoin increase requirement of oral contraceptives

  2. Carbamazepine, Phenytoin and Valproic acid have tetratogenic (can cause birth defects) effects

  3. There is inadequate information about risks for newer AED.

 

Types of adverse side effects

All these AED is associated with side effects that may be experienced or not and even if present may occur to different extent in different individuals. 3 categories of related side effects are:

        Dose related due to drug concentration in blood

More prominent at higher dose and qualitatively similar among the different AEDs. More frequent and exist at lower dose in patients taking a number of anticonvulsants concurrently, during initiation of therapy and especially when the dose is increased too rapidly. Usually mild but sometimes may limit the dose which can be used.

        Allergic response to drug

Generally rare and unpredictable. Non-dose related and usually occurs during the first few months of therapy. Close monitoring with report to the doctors when necessary.

        Long-term systemic effects of drug after its absorption into body

Tends to be drug-specific and no related to dose. Have significant impact on patients quality of life and can be avoided with preventive measures.

Generally, it is common for people on AED to experience drowsiness, fatigue, weight change, upset stomach and difficulties with concentration and memory. [ For side effects specific to each medication, please click on its name in the table above ]

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