Epilepsy Treatment: Finding the Right Medication
Newer Epilepsy Drugs: Higher Price, Fewer Side Effects
The perceived drawbacks of older epilepsy drugs spurred a renaissance of
development of new epilepsy drugs, launched in the 1990s:
- Keppra (levetiracetam) is one of the broad-spectrum epilepsy
drugs, meaning it is effective in most adults, regardless of the seizure type.
Keppra also has established benefits in difficult-to-treat seizures. Side
effects include sleepiness, dizziness, and anxiety, although Keppra is usually
- Lamictal (lamotrigine) is a broad-spectrum epilepsy drug as well. It's also
used to treat bipolar disorder. An extended release form is available. Side
effects of Lamictal most often include dizziness, blurred vision, insomnia, or
headache. A serious rash requiring medical attention can sometimes
- Topamax (topiramate) is a broad-spectrum epilepsy drug. It's also effective
migraines. Drowsiness, clumsiness, slowed or difficult speech and
concentration, and weight loss are common side effects of Topamax. Kidney
stones occur in 1% of people.
- Zonegran (zonisamide) is broad-spectrum, also. Drowsiness, clumsiness,
nausea, vomiting, and kidney stones (up to 4% of
people) are side effects. A serious rash occurs 1%-2% of the time.
- Felbatol (felbamate) is only used for severe seizures that are uncontrolled
by other treatments. Felbatol can cause a rare but potentially fatal blood
disorder called aplastic anemia. The risks of this side effect need to be
balanced against the risks of uncontrolled seizures.
The other new-generation epilepsy drugs are narrow-spectrum, meaning they
are only effective against seizures originating in a single part of the brain
- Neurontin (gabapentin) has no known serious side effects, although people
who have kidney disease should take a lower dose. Sedation, fatigue, dizziness,
and clumsiness are common side effects, which can be bothersome at high doses.
Neurontin can make generalized seizures worse, if present.
- Trileptal (oxcarbazepine) is related to the older carbamazepine.
It also has the potential to aggravate generalized seizures. Side effects
include fatigue, dizziness, double vision, nausea, vomiting, and headache. Like
carbamazepine, it can make birth
control pills less effective.
- Gabitril (tiagabine) helps control partial seizures, although in rare cases
it can trigger a form of uncontrolled seizures (status epilepticus). Common
side effects are fatigue, dizziness, sleepiness, clumsiness, and
- Lyrica (pregabalin) is better known as a treatment for fibromyalgia, but it
also treats partial seizures. Side effects commonly are fatigue, dizziness,
clumsiness, double vision, weight gain, and fluid retention.
- Vimpat (lacosamide) helps control
partial onset seizures in combination with other antiseizure medications.
DIzziness and nausea are the most common side effects.
Older-Generation Epilepsy Drugs
The older epilepsy drugs include Dilantin, Depakote, Tegretol, and phenobarbital.
Dilantin or Phenytek (phenytoin) is a narrow-spectrum epilepsy drug, widely
used for partial seizures. Dilantin has complex chemical properties in the
body, and small changes in dose can lead to wide swings in blood levels. Side
effects include fatigue, dizziness, clumsiness, nausea, and vomiting. Long-term
use can lead to thin bones (osteoporosis), facial hair, and excessive growth of
the gums. Dilantin increases the liver's metabolism of certain drugs, which can
cause a number of drug interactions. Birth
defects are also a concern if it's taken during pregnancy.