Location
Moultrie, GA
Start Date
7-5-2025 1:00 PM
End Date
7-5-2025 4:00 PM
Description
Introduction: Epilepsy is a chronic brain disorder characterized by recurrent seizures. ~3.4 million people in the US are affected, that is ~1.2% of the population. Focal seizures, the most common type, originate from a specific area of the brain, account for more than half of all seizures. Generalized seizures make up the rest, involving both brain hemispheres. Effective management is critical for improving patient outcomes and quality of life. This review provides an overview of potent antiepileptic pharmacotherapy in the US.
Methods: We explored the major drugs used to treat epilepsy based on available data from databases such as PubMed and Google search engine. We also conducted a thorough review of current drugs from CDC, NIH, FDA, Medscape, UpToDate, WHO and Epilepsy Foundation websites. After an initial review of abstracts, a subsequent full-text review of relevant articles were performed.
Results: The current treatment involves a range of antiepileptic drugs (AED), each with specific indications depending on the type of seizure and the patient’s individual characteristics. Diazepam and lorazepam are first-line treatments for acute seizures, particularly status epilepticus, due to their rapid onset and mechanism of actions enhancing GABA's inhibitory effects. These benzodiazepines are administered by physicians in emergency situations to quickly terminate seizure activity and prevent prolonged episodes. The 1st generation anticonvulsant phenytoin is effective to treat generalized and partial seizures in children and adults, but its therapeutic index is narrow. Fosphenytoin, a prodrug of phenytoin, is frequently used for prolonged seizure management, when immediate action is required. This drugs’ mechanism of action, short half-life and ability to be administered intravenously makes it suitable for acute management. It is a sodium channel blocker like valproic acid and carbamazepine, both used for long-term management. Having many additional mechanisms makes valproate a broad-spectrum drug effective for focal as well as generalized seizures, while carbamazepine is the first line for focal seizures. Levetiracetam is used in the management of both generalized and partial seizures and is often combined with carbamazepine for treating focal seizures due to its favorable side effect profile and ease of use. Lamotrigine and levetiracetam are also considered safe options during pregnancy, making an important choice for women of childbearing age. In pediatric patients with absence seizures, ethosuximide and valproic acid are used due to their efficacy and safety.
Discussion: The choice of AED depends on seizure type, patient age, comorbidities, and potential side effects. Benzodiazepines are effective acutely due to their GABA mediated inhibitory effects but long-term use causes sedation and dependence. Phenytoin is not the best option due to its potential for significant side effects and the availability of better tolerated drugs. Fosphenytoin is safe during prolonged seizure control, but often causes nystagmus, dizziness, and ataxia. Severe myelosuppression and dermatological toxicities are possible with long-term carbamazepine therapy, while valproate can cause GI symptoms and hepatotoxicity. Overall, treating epilepsy requires a tailored approach. While advancements in pharmacotherapy offer effective options, ongoing research is vital to refine these strategies and address the challenges of long-term AED use.
Embargo Period
6-4-2025
Included in
Current drugs for the management of epilepsy
Moultrie, GA
Introduction: Epilepsy is a chronic brain disorder characterized by recurrent seizures. ~3.4 million people in the US are affected, that is ~1.2% of the population. Focal seizures, the most common type, originate from a specific area of the brain, account for more than half of all seizures. Generalized seizures make up the rest, involving both brain hemispheres. Effective management is critical for improving patient outcomes and quality of life. This review provides an overview of potent antiepileptic pharmacotherapy in the US.
Methods: We explored the major drugs used to treat epilepsy based on available data from databases such as PubMed and Google search engine. We also conducted a thorough review of current drugs from CDC, NIH, FDA, Medscape, UpToDate, WHO and Epilepsy Foundation websites. After an initial review of abstracts, a subsequent full-text review of relevant articles were performed.
Results: The current treatment involves a range of antiepileptic drugs (AED), each with specific indications depending on the type of seizure and the patient’s individual characteristics. Diazepam and lorazepam are first-line treatments for acute seizures, particularly status epilepticus, due to their rapid onset and mechanism of actions enhancing GABA's inhibitory effects. These benzodiazepines are administered by physicians in emergency situations to quickly terminate seizure activity and prevent prolonged episodes. The 1st generation anticonvulsant phenytoin is effective to treat generalized and partial seizures in children and adults, but its therapeutic index is narrow. Fosphenytoin, a prodrug of phenytoin, is frequently used for prolonged seizure management, when immediate action is required. This drugs’ mechanism of action, short half-life and ability to be administered intravenously makes it suitable for acute management. It is a sodium channel blocker like valproic acid and carbamazepine, both used for long-term management. Having many additional mechanisms makes valproate a broad-spectrum drug effective for focal as well as generalized seizures, while carbamazepine is the first line for focal seizures. Levetiracetam is used in the management of both generalized and partial seizures and is often combined with carbamazepine for treating focal seizures due to its favorable side effect profile and ease of use. Lamotrigine and levetiracetam are also considered safe options during pregnancy, making an important choice for women of childbearing age. In pediatric patients with absence seizures, ethosuximide and valproic acid are used due to their efficacy and safety.
Discussion: The choice of AED depends on seizure type, patient age, comorbidities, and potential side effects. Benzodiazepines are effective acutely due to their GABA mediated inhibitory effects but long-term use causes sedation and dependence. Phenytoin is not the best option due to its potential for significant side effects and the availability of better tolerated drugs. Fosphenytoin is safe during prolonged seizure control, but often causes nystagmus, dizziness, and ataxia. Severe myelosuppression and dermatological toxicities are possible with long-term carbamazepine therapy, while valproate can cause GI symptoms and hepatotoxicity. Overall, treating epilepsy requires a tailored approach. While advancements in pharmacotherapy offer effective options, ongoing research is vital to refine these strategies and address the challenges of long-term AED use.