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As epilepsy drugs fail nearly one-third of patients, scientists seek root causes of seizures

After years of frustration, epilepsy researchers are shifting from targeting the seizures to seeking their cause, sometimes one patient at a time. Much about the condition remains a mystery, including why antiseizure medications fail so many people, among them more than 1 million in the United States. Yet leaps in gene sequencing and better animal models are changing how scientists and doctors understand, study, and—sometimes—treat the disease. The patients who stand to benefit include newborns with genetic syndromes who start to seize hours after birth and go on to suffer ruinous developmental delays, 10-year-olds who wake up wondering whether seizures will strike at school and battle difficulties…

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Featured

 Best Seizure Medication With the Least Side Effects

No single antiepileptic drug (AED) is better than the others to treat or prevent seizures. Doctors choose a particular seizure medicine for a specific patient after taking into account various factors such as the type of seizures, seizure frequency, side effects of different antiepileptic drugs, the convenience of use, cost (availability of generic substitution), in addition to the patient’s and physician’s previous experience with other seizure medications.

 New Epilepsy Drugs, Expanded Therapy Options How the Experts Choose

Newly-approved epilepsy drugs and other therapies in development may be effective in treating cases that were once resistant to treatment, epileptologists say. But while experts said they appear promising, they also were not ready to skip older options for which more data are available.

 The pharmacological treatment of epilepsy: recent advances and future perspectives

The pharmacological armamentarium against epilepsy has expanded considerably over the last three decades, and currently includes over 30 different antiseizure medications. Despite this large armamentarium, about one third of people with epilepsy fail to achieve sustained seizure freedom with currently available medications

Articles of Interest

New treatment options for people with drug-resistant epilepsy

An estimated 65 million people worldwide have epilepsy, and one in 26 Americans will develop epilepsy in their lifetime. Most of these people are able to control their seizures with medications, but approximately 30% to 40% have what’s called drug-resistant or medically refractory epilepsy, in which they don’t respond to standard anti-seizure medications.

A New Hope for Patients With Epilepsy

Although there is no cure, these anti-seizure drugs turn the disease into a chronic, but well-managed condition for many to the point where it barely interferes with life. But about one-third of patients aren’t so lucky. They experience no relief from anti-seizure drugs and are looking for additional treatment options. Now they may have found one in a new generation of neurostimulation devices used for epilepsy.

Antiepileptic drug monotherapy for epilepsy: a network meta‐analysis of individual participant data

High‐certainty evidence demonstrates that for people with focal onset seizures, current first‐line treatment options carbamazepine and lamotrigine, as well as newer drug levetiracetam, show the best profile in terms of treatment failure and seizure control as first‐line treatments. For people with generalised tonic‐clonic seizures (with or without other seizure types), current first‐line treatment sodium valproate has the best profile compared to all other treatments, but lamotrigine and levetiracetam would be the most suitable alternative first‐line treatments,...

Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review

A review of the risks of major congenital malformations and of adverse neurodevelopmental outcomes for antiepileptic drugs by the Commission on Human Medicines has confirmed that lamotrigine (Lamictal) and levetiracetam (Keppra) are the safer of the medicines reviewed during pregnancy.

Epilepsy: what are the best medications?

For people with generalised epilepsy, there was moderate-certainty evidence for sodium valproate being the best for seizure control, with lamotrigine and levetiracetam in second place. Note however that sodium valproate is associated with a relatively high risk of developmental problems in babies of mothers taking the drug during pregnancy. Therefore women of childbearing ages will usually be recommended one of the alternative drugs.

How One Boy's Fight With Epilepsy Led To The First Marijuana-Derived Pharmaceutical

The first prescription medication extracted from the marijuana plant is poised to land on pharmacists' shelves this fall. Epidiolex, made from purified cannabidiol, or CBD, a compound found in the cannabis plant, is approved for two rare types of epilepsy. Its journey to market was driven forward by one family's quest to find a treatment for their son's epilepsy.

New Epilepsy Drugs Offer More Solutions

Specifically, the AAN guidelines recommend four of the new drugs for newly-onset epilepsy: oxcarbazepine, gabapentin (Neurontin), lamotrigine, and topiramate (Topamax). The guidelines also recommended seven new drugs as additional medications for adults who have seizures that haven't responded to other medications: gabapentin, lamotrigine, topiramate, levetiracetam (Keppra), oxcarbazepine, tiagabine (Gabitril), and zonisamide (Zonegran).

Past, Present, and Future In the Search for the Perfect Anti-epileptic Drug

This paper explores the development of anti-epileptic drugs, starting with the earliest forms of treatment, moving to the drugs currently in use and those recently approved by the FDA, and ending with the drugs (and devices!) that will likely be approved for use in the near future.

Seizure medication side effects: what to do about them?

Have you recently started taking anti-epilepsy drugs (AEDs) and noticed medication side effects? Epilepsy medication side effects are very common - studies suggest that almost 60% of people on AED’s experience at least one side effect.

Some Epilepsy Drugs Linked to Cardiovascular Disease

The researchers used receipt of four consecutive enzyme-inducing antiseizure medications (eiASMs; carbamazepine, eslicarbazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, rufinamide, or topiramate) following an adult-onset (age >18 years) epilepsy diagnosis or repeated exposure in a weighted cumulative-exposure model. The researchers concluded that the hazard of incident cardiovascular disease is greater in patients receiving eiASMs.

Treating Epilepsy’s Toughest Cases

Current medicines fail to relieve seizures in about a third of people with epilepsy. What can be done?

What Are The Most Common Anti-Epilepsy Drugs?

Over the past 40 years new anti-epilepsy drugs have become available which enable about 75% of people with epilepsy to live seizure free.

Resources

10 Common Antiepileptic Seizure Medications to Know

Epilepsy occurs when people experience seizures repeatedly. There are many seizure medications that treat different types of seizures. Some of these medications require blood monitoring to ensure that they’re used safely and effectively. Your healthcare provider will determine the best seizure medication for you, based on how well they control your seizures and any side effects you experience.

North American AED Pregnancy Registry

The North American AED Pregnancy Registry is dedicated to answering this question. Anticonvulsants treat disorders like epilepsy, mood disorder, and chronic pain, but more information is needed about them to answer the question confidently. If you’re already taking anticonvulsants and are pregnant, please consider sharing your experience with us to help other women like yourself. Your identity will remain confidential.

StatPearls

Anti-epileptic drugs (AEDs) are numerous. There are a variety of mechanisms of action, and some AEDs possess multiple mechanisms of action. Although precise mechanisms of some drugs remain elusive, anti-seizure medications tend to be grouped by their principal mode of action.