Epilepsy - Medications

Highlights	Diagnosis	Surgery
Introduction	Treatment	Lifestyle Changes
Causes	Long-Term Treatment	Resources
Outlook and Effects	Medications	References

text continues below

Medications

According to a 2000 survey, the anti-epilepsy drug arsenal has nearly doubled in size since 1993. As a result, doctors have been able to offer many of their patients drugs with improved effectiveness, tolerability, and safety. Depending on the seizure type, certain standard AEDs are usually used first (called first-line drugs). If they fail, or if the patient becomes tolerant to the primary AEDs, then newer so-called add-on or second-line AEDs are tried, usually in combination with the standard drugs. The lines are beginning to blur, however, as studies on the newer second-line drugs add to the evidence of their effectiveness and tolerability.

Valproate and Divalproex Sodium

Valproate (Depakene, valproic acid) and its delayed release form, divalproex sodium (Depakote), are anticonvulsants. Valproate is the most widely prescribed anti-epileptic drug worldwide. It is the first choice for patients with generalized seizures and is used to prevent nearly all other major seizures as well.

General Side Effects. These drugs have a number of side effects that vary depending on dosage and duration. Most side effects occur early in therapy and then subside. General side effects include:

Stomach and intestinal problems, which are experienced by nearly half of patients after starting the drugs and may still occur after several years of use. Divalproex sodium (Depakote) has a lower risk for these side effects than valproate (Depakene).
Increased appetite with significant weight gain often becomes a problem and can be a major reason for noncompliance, particularly in young people.
Hand tremors, irritability, and hyperactivity in children are fairly common.
Temporary hair thinning and hair loss have occurred; taking zinc and selenium supplements may help reduce the effect.
Young girls may develop secondary male characteristics, and premenopausal women are at increased risk for menstrual irregularities and polycystic ovaries, due to elevated male hormones. The effects are reversible. (These side effects also appear in women using other anti-epileptic drugs, but the risk from valproate appears to be higher.)
Studies are reporting symptoms of Parkinson's disease preceded by hearing loss in people who have taken it for more than a year, but they were reversible when the drug was withdrawn.

Toxic Side Effects.

Cases of pancreatitis, a serious and even life-threatening inflammation in the pancreas, have been reported in children and adults taking valproate. (It is still very rare, however.)
The drug poses a significant risk for birth defects.
Valproate and divalproex sodium are not usually recommended for young children because of an unusual, but potentially fatal, toxic effect on the liver. It should be noted that this very rare effect is most likely to affect children under two years of age who have birth defects and are taking more than one antiseizure drug. Some doctors recommend monitoring of blood levels for liver function once before administering valproate or divalproex sodium, monthly during the first six months, and then periodically after that.
Children with epilepsy who take valproic acid may eventually develop some problems in the kidney, although according to a 2001 study, they are generally not significant.