Epilepsy medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Pharmacologic medical therapies for epilepsy is anti-seizure drugs such as:

• Carbamazepine:
  • It can be used in treatment of both generalized and focal epilepsy.
  • The initial dose is 2-3 mg/kg per day divided into at least two time.
  • The maximum dosing is 10 mg/kg three-times-daily.
  • The most common side effects of this drug are GI disturbance, rash, hyponatremia and fluid retention.^{[1] [2]}
• Eslicarbazepin
  • It can be used for treatment of focal-onset seizures in adult and children under 4 y/o.^[3]
  • The initial dosage is 400 mg/daily for adults.
  • The maximum dosing is maintenance dose of 800 mg/daily.^[4]
  • The most common side effects of this drug are dizziness, drowsiness, nausea, headache, fatigue, vertigo, ataxia, diplopia, blurred vision, and tremor.^[5]
• Lacosamide
  • It can be used for treatment of focal-onset seizures in adult and children older than 4 y/o.^[6]
  • The initial dosage is 50 mg twice/daily as adjunctive therapy in adults and 100 mg twice per day as monotherapy .
  • The maximum dosage is 200 to 400 mg per day. Children should be dosed according to body weight.^[7]
  • The most common side effects are Dizziness, nausea, vertigo, and ataxia.^[8]
• Lamotrigine
  • It can be used for adjunctive treatment for primary generalized tonic-clonic seizures and focal seizures in adults and children under two y/o.^[9]
  • The initial dosage is 25 mg/daily.
  • The maximum dosage is 225 to 375 mg/daily^[10]
  • The most common side effects are rash and nausea.^[11]
• Oxcarbazepine
  • It can be used for treatment of focal and secondarily generalized tonic-clonic seizures.^[12]
  • The initial dosage is 300 to 600 mg/day.
  • The maximum dosage is 900 to 3000 mg/day.^[13]
  • The most common side effects are hyponatremia, sedation, headache, rash, dizziness, vertigo, ataxia, nausea, and diplopia.^[14]
• Phenytoin
  • It can be used for treatment of focal/generalized seizures and status epilepticus.^[15]
  • The initial dosage is 15 mg/kg/day in three doses.^[16]
  • The most common side effects are gingival hypertrophy, hirsutism, rash, folic acid depletion, and decreased bone density.^[17]
• Rufinamide
  • It can be used for adjunctive treatment of seizures associated with Lennox-gastaut syndrome (LGS).^[18]
  • The initial dosage In children is 10 mg/kg per day in two divided doses and in adults is 400 to 800 mg per day in two divided doses.
  • The maximum dosage in children is 45 mg/kg per day or 3200 mg/day and in adults is 3200 mg/day.^[19]
  • The most common side effects are drowsiness and vomiting.^[20]
• Zonisamide
  • It can be used for treatment of focal and generalized seizures in both adults and children.^[21]
  • The initial dosage is 100 to 200 mg/daily in two divided doses.
  • The maximum dosage is 400 to 600 mg/daily.^[22]
  • The most common side effects are drowsiness, anxiety, ataxia, anorexia, confusion, abnormal thinking, fatigue, dizziness and decreased sweating and fever in children. ^[23]

• Ethosuximide
  • It can be used for treatment of absence seizures.
  • The initial dosage is 20 to 40 mg/kg/day.
  • The maximum serum level is 40 to 100 mcg/mL (280 to 700 micromol/L).
  • The most common side effects are nausea and vomiting, sleep disorders and somnolence.^[24]

• Benzodiazepines
  • It can be used for adjunctive therapy for myoclonic/atonic seizures and focal/generalized tonic-clonic seizures.
  • The most common side effects are anterograde amnesia, drowsiness and increased risk of falling in elderly persons.^[25]
• Phenobarbital
  • It can be used for treatment of generalized and focal seizures.
  • The initial dosage is 1 to 5 mg/kg per day.
  • The goal therapeutic level is 10 to 40 mcg/mL (43 to 172 micromol/L).^[26]
  • The most common side effects are sleep disturbance and daytime irritability.^[27]
• Tiagabine
  • It can be used for adjunctive treatment for focal seizures.^[28]
  • The initial dosage is 4 to 8 mg/day.
  • The most common side effects are dizziness, somnolence, anxiety, tremor, difficulty concentrating, nausea and abdominal pain.^[29]
• Vigabatrin
  • It can be used for add-on treatment for refractory focal seizures.^[30]
  • The initial dosage is 500 mg/day.
  • The maximum dosage is 3 gr/day.^[31]
  • The most common side effects are visual loss, drowsiness, fatigue, headache, and dizziness.^[32]

• Perampanel
  • It can be used for treatment of focal-onset seizures in patients older than 12 y/o and as adjunctive treatment for primary generalized tonic-clonic seizures.^[33]
  • The initial dosage is 2 mg/day.
  • The maximum dose is 12 mg/day.^[34]
  • The most common side effects are dizziness, drowsiness, headache, fatigue, irritability, ataxia, nausea, and weight gain.^[35]

• Felbamate
  • It can be used for treatment of focal seizures and Lennox-Gastaut syndrome (LGS).^[36]
  • This drug can cause fatal aplastic anemia and hepatic failure.^[37]
• Topiramate
  • It can be used for treatment of focal seizures in adults and children older than two y/o.^[38]
  • The initial dosage is 50 mg/day.^[39]
  • The most common side effects are Weight loss, paresthesias, drowsiness, dizziness, depression, headache, cognition and language impairment.^[40]
• Valporate
  • It can be used for treatment of generalized and focal seizures.
  • The initial dosage is 10 to 15 mg/kg per day.^[41]
  • The most common side effects are nausea, vomiting, hair loss, easy bruising, tremor, weight gain, obesity, insulin resistance, metabolic syndrome, thrombocytopenia and other coagulation disturbances, subclinical hypothyroidism, polycystic ovarian syndrome, fanconi syndrome.^{[42][43][44][45][46]}

• Brivaracetam
  • It can be used for treatment of focal-onset seizures and generalized epilepsy.^[47][48]
  • The initial dosage is 50 mg twice daily.^[49]
  • The most common side effects are irritability, anxiety, insomnia and depression.^[50]
• Gabapentin
  • It can be used for treatment of refractory focal seizures.^[51]
  • The initial dosage is 300 mg three times daily.
  • The maximum dosage is 2400 mg/day.^[52]
  • The most common side effects are sedation, dizziness, ataxia and weight gain.^[53]
• Levetiracetam
  • It can be used for adjunctive treatment of focal-onset seizures, myoclonic seizures in patients older than 12 y/o with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients older than six y/o with idiopathic generalized epilepsy.^[54][55][56]
  • The initial dosage is 500 mg twice daily.
  • The maximum dosage is 4000 mg daily.^[57]
  • The most common side effects are fatigue, drowsiness, dizziness, and upper respiratory tract infection.^[58]
• Pregabalin
  • It can be used for adjunctive therapy for focal seizures.^[59]
  • The initial dosage is 150 mg daily in either two or three divided doses.^[60]
  • The most common side effects are dizziness, gait abnormalities and drowsiness.^[61]

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