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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
Oxcarbazepine
|
Gabapentin
#
|
Phenobarbital
|
| 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 |
Lamotrigine |
Topiramate # |
| Absence Seizure (Petit Mal) | Ethosuximide
|
Lamotrigine | Phenobarbital |
| Myoclonic Seizure | Valproic Acid |
Nitrazepam
|
|
| Atypical Absence Seizure, Atonic Seizure | Valproic Acid | Lamotrigine | Felbamate
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:
# 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:
Carbamazepine and Phenytoin increase requirement of oral contraceptives
Carbamazepine, Phenytoin and Valproic acid have tetratogenic (can cause birth defects) effects
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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