Seizures: Treatment Overview

Reviewed by the Office of Clinical Evaluation and Policy (OCEP), Evernorth

Patients with epilepsy, a condition characterized by recurring seizures, often require lifelong treatment in the form of medication. For most patients with epilepsy (around 70%), medication can help manage seizures. Although medication is the cornerstone of therapy for treating seizures, choosing the right medication for seizures can require a targeted strategy.

Several treatment options are available to treat seizures. Medications for seizure disorders, called anticonvulsants or antiepileptic drugs, may work in different ways to help normalize electrical activity in the brain. The goal of seizure treatment is to find the most effective medication to stop seizures, with the fewest side effects

Continue reading to learn more about treatment options for seizures.

Starting treatment for seizures

Starting treatment with a specific medication will largely depend on the type of seizure that occurs. The types of possible seizures include focal, generalized, and unknown onset. Focal onset seizures include focal onset aware and focal onset impaired awareness seizures, while generalized onset seizures include tonic-clonic and absence seizures. Seizures in which the part of the brain the seizure starts is unknown are called unknown onset seizures.

The antiepileptic drug prescribed usually falls into one of two categories: broad-spectrum and narrow-spectrum. Broad-spectrum antiepileptic drugs are useful as an initial treatment, especially for cases where the seizure type is not yet known. On the other hand, narrow-spectrum antiepileptic drugs are primarily used to treat focal (formerly known as partial) seizures.

Some drugs may be used alone or in combination with other drugs to manage seizures. A healthcare provider can recommend the best treatment based on an overall assessment of the condition.

Commonly prescribed antiepileptic drugs

Lamotrigine (Lamictal®)

Lamotrigine is a broad-spectrum antiepileptic drug. It can be used to treat focal-onset seizures and primary generalized tonic-clonic seizures and generalized seizures of Lennox-Gastaut syndrome. It is also prescribed as a mood stabilizer because of its activity on certain neurotransmitters in the brain. Side effects include dizziness, nausea, and drowsiness.

Topiramate (Topamax®, Qudexy XR®,Trokendi XR®)

Topiramate is a broad-spectrum antiepileptic drug. It can be used to treat focal-onset, primary generalized tonic-clonic seizures and seizures and Lennox-Gastaut syndrome. It also can be prescribed to prevent migraines. Side effects of topiramate include fatigue, dizziness, nausea, and cognitive problems, such as confusion and problems with memory.

Valproic Acid Derivatives

Depakote (divalproex sodium) is a valproate product made up of sodium valproate and valproic acid. Valproic acid is the generic name for the now-unavailable brand Depakene. These valproic acid derivatives are broad-spectrum antiepileptics that can treat focal and generalized seizures. They may cause side effects, such as dizziness, changes in weight, tremor, and nausea or vomiting. Depakote may also be prescribed for mood disorders or to prevent migraines.

Levetiracetam (Keppra®, Spritam®, ElepsiaTM XR)

Levetiracetam is a broad-spectrum antiepileptic drug that is typically used along with other medications to treat focal-onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in certain patients. Levetiracetam is well-tolerated and does not need a long period for titration. Side effects of levetiracetam include drowsiness, weakness, fatigue, and dizziness.

Carbamazepine (Tegretol®, Equetro®, Carbatrol®, Epitol®)

Carbamazepine is a narrow-spectrum antiepileptic drug usually prescribed for focal and generalized seizures. It may also be used to treat mood disorders and trigeminal neuralgia. It may cause certain side effects, such as dizziness, nausea, vomiting, blurred vision, headache, and rash.

Phenytoin (Dilantin®, Phenytek®)

Phenytoin is a narrow-spectrum antiepileptic drug commonly used for focal and generalized seizures. It can also be used to treat status epilepticus and prevention of seizures in certain situations, such as after neurosurgery. Side effects may include increased body hair growth, worsened bone density, and rash.

Pregabalin (Lyrica®)

Pregabalin is a narrow-spectrum antiepileptic drug used along with other medications to treat focal onset seizures. It can also be used to treat nerve pain and fibromyalgia. Side effects of pregabalin include dizziness, drowsiness, dry mouth, blurred vision, weight gain, and swelling of the arms and legs.

Gabapentin (Neurontin®)

Gabapentin is a narrow-spectrum antiepileptic drug used in combination with other medications to treat focal onset seizures. It is also approved to treat nerve pain and restless leg syndrome. Side effects of gabapentin include drowsiness, fatigue, nausea, and impaired coordination.

Getting the right treatment

Antiepileptic drugs come in brand and generic versions that may be covered by Medicare and health insurance plans. Consult a healthcare provider about potential side effects, drug interactions, and monitoring requirements before starting treatment. Medications are usually started at a low dose and increased gradually (titrated) to the most effective dose. During treatment, dosages may need to be adjusted.

Sources:

• https://www.ncbi.nlm.nih.gov/books/NBK482269/