Table Of Contents
Anti-epileptic drugs (AEDs)
AEDs should only be commenced by a specialist after the diagnosis of epilepsy has been confirmed. The choice of AEDs depends on seizure types, comorbidities, lifestyle and the patient’s preference. All AEDs are teratogenic. Valproate is the most teratogenic and may cause TTP. Lamotrigine may cause Stevens-Johnson syndrome (start gradually and stop gradually)
| Seizure type | 1st line | 2nd line |
|---|---|---|
| Focal seizures | Carbamazepine, Lamotrigine | Levetiracetam, Oxcarbazepine, Valproate |
| Generalized tonic-clonic seizures | Valproate, Lamotrigine | Carbamazepine, Clobazam, Levetiracetam, Topiramate |
| Absence seizures | Valproate or Ethosuximide | Lamotrigine |
| Myoclonic seizures | Valproate | Levetiracetam, Topiramate. Avoid Carbamazepine and Oxcarbazepine as they may worsen the seizures |
| Tonic or atonic seizures | Valproate or Lamotrigine |
- Are antiepileptics started after the patient’s first seizure?
- No
- Does a normal EEG rule out epilepsy?
- No (might have a seizure every 8 months, etc.)
- Drug of choice for absence seizures?
- Ethosuximide
- First-line agents for simple or secondary generalized seizures?
- Carbamazepine
- Oxcarbazepine
- Lamotrigine
- Topiramate
- Drug of choice for generalized epilepsy or unclassified epilepsy?
- Valproic acid (Depakote) – has a fairly good spectrum
- Drugs with the broadest spectrum of action?
- Lamotrigine
- Topiramate
- Why do creatine kinase levels go up after seizures?
- Muscle contraction → increased release of CK into bloodstream
- When to stop AEDs
- Seizure free for > 2 years after assessing risk and benefits for the individuals (e.g. the need to drive)
- Decrease dosage slowly over 2-3 months or > 6 months for benzodiazepines and barbiturates
