Epilepsy - Medications

Primidone. Primidone (Mysoline) is converted in the body to phenobarbital, and so has the same benefits and adverse effects. It is reported that primidone is not as well tolerated as phenobarbital. Some authorities even believe that primidone has no advantage over the other drug.

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Ethosuximide and Similar Drugs

Ethosuximide (Zarontin) is used for petit mal (absence) in children and adults when the patient has experienced no other type of seizures. Ethosuximide succeeds in abolishing petit mal seizures in 60% of patients and controls them in up to 90%. Use of this drug can cause stomach problems, dizziness, loss of coordination, and lethargy. In rare cases, it has caused severe and even fatal blood abnormalities. Periodic blood counts are recommended for patients taking this drug.

Methsuximide (Celontin), a drug similar to ethosuximide, may be suitable as an add-on treatment for intractable epilepsy in children without causing serious or permanent side effects.

Clonazepam and Similar Drugs

Clonazepam (Klonopin) is recommended for myoclonic and atonic seizures that cannot be controlled by other drugs and for Lennox-Gastaut (absence variant). It may be useful in newborns in whom other drugs are ineffective. Although clonazepam can prevent generalized or partial seizures, patients generally develop tolerance to the drug, and then seizures recur.

Side Effects. People who have had liver disease or acute angle glaucoma should not take clonazepam, and people with lung problems should approach the drug with caution. Clonazepam can be addictive and abrupt withdrawal has been known to trigger status epilepticus. Side effects include the following: drowsiness, imbalance and staggering, irritability, aggression, hyperactivity in children, weight gain, eye muscle problems, slurred speech, tremors, skin problems, and stomach problems.

Add-Ons or Secondary AEDs

Many newer AEDs are now available and are usually better tolerated than the older, standard AEDs. They often cause less sedation and require less monitoring. Although they are generally approved for use as add-ons to standard drugs that fail to control seizures, many doctors are now prescribing them as single drugs. Specific choices usually depend on the individual's particular condition and the specific side effects of the AED. None as yet has emerged as being superior to either standard or newer drugs. All appear to offer some benefits, but as with standard antiseizure drugs, they also have troublesome side effects.

Lamotrigine. Lamotrigine (Lamictal) is effective as add-on therapy and is well tolerated in treating partial and generalized seizures. It has now been approved as monotherapy for partial seizures in adults who have not responded to standard drugs and as add-on therapy for children with partial seizures and Lennox-Gastaut syndrome. Studies overseas have suggested that it is as effective as carbamazepine and phenytoin and patients tolerate it better. Lamotrigine may be a good alternative for people who experience weight gain or other hormone-related side effects from valproate. Lamotrigine may not have the adverse effects on sexual function in men as some other antiseizure drugs have. The drug also appears to improve cholesterol levels.