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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 well-tolerated.
  • 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 occur. 
  • Topamax (topiramate) is a broad-spectrum epilepsy drug. It's also effective in treating 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 (partial seizures):

  • 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 nervousness.
  • 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.

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