Epilepsy - Medications

Note: Citrus fruit, especially grapefruit, can increase carbamazepine's adverse effects and should be avoided by those taking this drug.

Phenytoin

Phenytoin (Dilantin) is effective for adults who have the following seizures or conditions:

Grand mal seizures.
Partial seizures.
Status epilepticus
Can be effective for people with head injuries who are at high risk for seizures.

This drug is not useful for the following seizures:

Petit mal seizures.
Myoclonic seizures.
Atonic seizures.

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Side Effects. Side effects are sometimes difficult to control. Some people may develop a toxic response to normal doses, while others, such as those with alcoholism, may require higher doses to achieve benefits. As with any drug, side effects generally rely on dosage and duration. Using phenytoin in combination with newer add-on drugs can allow lower doses and may reduce some of the risks. Side effects include:

Excess body hair, eruptions and coarsening of the skin, and weight loss.
Gum disease.
Staggering, lethargy, nausea, depression, eye-muscle problems, anemia, and an increase in seizures can occur as a result of high doses.
The part of the brain that affects muscular stability can be damaged as a result of taking this drug in very high amounts or for long periods of time.
Liver damage may develop in rare cases.
Long-term therapy can cause bone loss. Patients should take preventive calcium and vitamin D supplements and exercise regularly to improve bone mass.
Severe and even rare life-threatening skin reactions (e.g., Stevens-Johnson syndrome).

Barbiturates (Phenobarbital and Primidone)

Phenobarbital. Phenobarbital (Luminal), also called phenobaritone, is a barbiturate anticonvulsant and is often the initial drug prescribed for newborns and young children. It is a relatively inexpensive drug and is used to also prevent grand mal (tonic-clonic) seizures or partial seizures, particularly in economically disadvantaged areas. Phenobarbital has fewer toxic effects on other parts of the body than most anti-epileptic drugs, and drug dependence is unusual, given the low doses used for patients with epilepsy. Nevertheless, withdrawal is common because of side effects, and therefore it is less likely to be used over time than other drugs, including phenytoin, another relatively inexpensive but effective drug.

Side Effects. Patients sometimes describe their state as "zombie-like." The most common and troublesome side effects are:

Drowsiness.
Memory problems.
Problems with tasks requiring sustained performance.
Problems with motor skills.
Hyperactivity in some patients, particularly in children and the elderly.
Depression in some adults.
Some controversy has arisen over studies indicating that children taking phenobarbital score lower on intelligence tests, even for some months after going off the drug.