Epilepsy Medication: Types and Available Options

Medically reviewed by Alex Yampolsky, PharmD

Medications that treat epilepsy vary based on the type of seizure disorder. There are two main types of epilepsy drugs: narrow-spectrum anti-epileptic drugs (AEDs) and broad-spectrum AEDs.

Generally, medications used to help manage seizures work by slowing down certain channels in the brain that can become overexcited, which can lead to temporary muscle spasms, muscle stiffness, or loss of consciousness.

This article will explain the different types of epilepsy medications, what kind of epilepsy disorders they can treat, and which medication may be right for you.

Types of Epilepsy Medications

There are two types of epilepsy medications: narrow-spectrum anti-epileptic drugs (AEDs) and broad-spectrum AEDs. Your healthcare provider may prescribe one or multiple AEDs, depending on your specific seizure disorder.

Controlled Substances

Some AEDs have been categorized as controlled substances, including:

• Lyrica (pregabalin)

• Vimpat (lacosamide)

• Fycompa (perampanel)

• Phenobarbital

• Brivact (brivaracetam)

• Xcopri (cenobamate)

• Klonopin (clonazepam)

Before starting treatment, talk with your healthcare provider about the potential risks associated with these medications.

Narrow-Spectrum AEDs

Narrow-spectrum AEDs can treat specific types of seizures, such as focal onset seizures, also known as partial seizures.

Carbamazepine

Carbamazepine, marketed under the brand name Tegretol, is used to treat epilepsy. It is also approved to treat pain associated with trigeminal neuralgia. Carbamazepine works by reducing the amount of sodium that can pass through the cell membranes in your brain. This helps reduce the amount of seizures.

This medication comes in different oral forms, including tablets, capsules, and a liquid suspension. Immediate-release and extended-release versions are available.

Carbamazepine may interact with birth control pills, so it can make oral contraceptives less effective when taking them simultaneously. Therefore, it is recommended to use an additional form of contraception while taking carbamazepine.

Eslicarbazepine

Aptiom (eslicarbazepine) is a medication used to treat focal onset seizures in people 4 years and older. It comes in orally taken tablet form. Doses are often consumed once a day.

Like carbamazepine, eslicarbazepine works by changing the amount of sodium that passes through certain parts of your brain, which can then reduce the number of seizures you may experience. Also, eslicarbazepine makes birth control pills less effective, so another form of contraception is recommended for those trying to prevent pregnancy.

Ethosuximide

Zarontin (ethosuximide) is used to treat absence seizures. Ethosuximide works by reducing certain activity in the nervous system, which can help reduce seizures. It comes in capsule or liquid (syrup) form and is typically taken one or more times daily.

Gabapentin

Neurontin (gabapentin) is sometimes prescribed as an add-on treatment for focal seizures. This means it's usually prescribed along with other AEDs. The way gabapentin works for seizures is not well known.

Gabapentin may be used in adults and children 3 years and older. It can be taken in an oral capsule, tablet, or solution form. It is generally dosed three times daily.

Lacosamide

Vimpat (lacosamide) can help manage focal seizures in adults and children 4 years and older. It can be used alone (monotherapy) or with another AED (adjunctive therapy). Lacosamide reduces the amount of chemicals in your brain that can cause seizure activity. It slows or limits brain and neuronal overactivity through several mechanisms involving sodium channels in the cell membranes.

Vimpat comes in tablet and solution forms. It can also be given intravenously (into the veins). It is typically dosed once daily.

Certain side effects seen with lacosamide can include double vision or involuntary muscle movements.

Oxcarbazepine

Oxcarbazepine, also known as Trileptal or Oxtellar XR (extended-release version), is a medication used to manage focal seizures in the following:

• Adults: As a monotherapy or add-on therapy

• Children 4 and older: As a monotherapy or add-on therapy

• Children 2 to 4: As an add-on therapy

Oxcarbazepine can be taken in tablet or suspension form. Dosing will depend on age.

The way oxcarbazepine works in the body is not well known. However, it is thought to block sodium channels in the brain to decrease nerve impulses, which helps prevent seizures.

Phenobarbital

Phenobarbital belongs to a class of medications called barbiturates, which are used as sedatives and anti-seizure medications. It can be used to treat generalized or focal seizures and neonatal seizures.

Phenobarbital is thought to help prevent seizures by stabilizing electrical activity in the brain.

Before you take phenobarbital, make sure to discuss with your healthcare provider the risks involved with barbiturates. This includes its increased risk of dependence or addiction. Stopping the use of phenobarbital after taking it for a while can cause withdrawal.

Phenytoin

Dilantin (phenytoin) is used for multiple types of seizure disorders, including tonic-clonic seizures (formerly known as grand mal seizures) and psychomotor (temporal lobe) seizures. It can also prevent and treat seizures after surgery on the brain.

Dilantin works by blocking sodium channels, which helps slow the spread of seizure activity. It comes in capsule, tablet, and liquid forms. Depending on the dosage form, you might take it anywhere from one to four times daily.

Pregabalin

Lyrica (pregabalin) is used as an add-on therapy for focal seizures in adults and children 1 month and older.

Pregabalin works by binding to a specific part of your nervous system, where it can adjust how much of certain chemicals your brain gets, which can help better manage seizure frequency.

You can take pregabalin orally in capsule or liquid form. It is usually taken anywhere from one to three times per day, depending on the dosage form.

Pregabalin can cause respiratory depression when taken with other medications that affect the brain (e.g., central nervous system depressants). Before starting treatment, discuss your other medications with your healthcare provider.

Vigabatrin

Sabril (vigabatrin) is used to help treat a type of seizure called refractory complex partial seizures in adults and children 10 years and older. In this condition, other AEDs have failed to adequately control seizures. Your healthcare provider may prescribe vigabatrin if other medications have not worked for you.

Vigabatrin works by increasing levels of a chemical in your brain called gamma-aminobutyric acid (GABA). This helps reduce seizure frequency.

Importantly, vigabatrin has a boxed warning about the risk of vision loss from using this medication. Periodic vision assessments are generally required for people taking vigabatrin, although this will not necessarily prevent vision damage.

Vigabatrin comes in tablet form or powder to mix with water for oral consumption.

Broad-Spectrum AEDs

Broad-spectrum AEDs often treat generalized seizures, which have symptoms more commonly associated with involuntary movements and loss of consciousness, or a wide variety of seizure disorders.

Brivaracetam

Brivact (brivaracetam) treats focal seizures in adults and children 1 month and older. It is available in tablet and liquid solution forms for oral use, or as an injection.

The way brivaracetam works is not well known, but it reduces the number of seizures you can develop. If you are currently taking other AEDs, such as carbamazepine or phenytoin, make sure to let your healthcare provider know. Taking other AEDS at the same time can affect the level of brivaracetam in your body.

Cannabidiol

Epidiolex (cannabidiol) is a prescription drug made with cannabidiol (CBD) used to treat seizures associated with Lennox-Gaustat syndrome (LGS) or Dravet syndrome in people 2 years and older. It is available in an oral solution.

CBD is derived from the cannabis (marijuana) plant. However, it does not contain the euphoric properties or abuse potential associated with marijuana.

The way Epidiolex works to help manage seizures is unknown.

Cenobamate

Xcopri (cenobamate) is a medication used to treat focal seizures in adults.

It works by reducing the amount of chemical excitement in the brain that can cause you to develop seizures. Before starting cenobamate, talk to your healthcare provider about getting your liver, kidney, and heart function checked.

Cenobamate may also reduce how well birth control pills work, so you should use another form of contraceptives to prevent pregnancy.

Clonazepam

Klonopin (clonazepam) is a benzodiazepine commonly used to treat certain mental health conditions, such as panic disorder, but it also can be used to treat seizure disorders. It's helpful as a monotherapy or add-on therapy for LGS, akinetic seizures, and myoclonic seizures. People who have absence seizures and have not responded to other therapies may also benefit.

The exact way in which clonazepam works for seizures is not well understood. Clonazepam acts on the activity of GABA, an inhibitory neurotransmitter in the central nervous system, and this is thought to play a role in its anti-seizure effects.

Felbamate

While Felbatol (felbamate) is approved to treat seizure disorders in adults and children, it is rarely used due to its severe side effects. It has been associated with liver failure and blood disorders, such as aplastic anemia.

Felbamate is only considered a last-line medication when other therapies fail to control seizures.

Lamotrigine

Lamcital (lamotrigine) can be used for tonic-clonic seizures and focal seizures. The way lamotrigine works in the body is not well understood. However, research has shown that lamotrigine enhances GABA release and inhibits glutamate release. This calms down the central nervous system to reduce seizure frequency.

Lamotrigine comes in different tablet forms, including immediate-release tablets, chewable dispersible tablets, and orally disintegrating tablets.

If you are pregnant, lamotrigine may be recommended as it is safer than many other AEDs to use while pregnant.

Levetiracetam

Keppra (levetiracetam) is often used to manage focal seizures, usually in combination with other AEDs, in adults and children 1 month and older. It can also be used for:

• Myoclonic seizures in people 12 and older with juvenile myoclonic epilepsy

• Primary generalized tonic-clonic seizures in people 6 and older with idiopathic generalized epilepsy

The way levetiracetam works in the body is unknown. It is available in tablet and liquid formulations.

Levetiracetam may be prescribed if you are pregnant, as it is safer to use than other AEDs. Common side effects that may be seen with levetiracetam can include sleepiness and mood changes.

Perampanel

Fycompa (perampanel) treats focal seizures with or without secondarily generalized seizures and primary generalized tonic-clonic seizures in people 12 years and older. It is used in addition to other AEDs.

Fycompa is taken in capsule or liquid suspension forms. The dosing your healthcare provider may start you at will depend on other medication for seizures you may be taking.

The FDA warns about the potential for severe mental health and behavioral reactions that could result in aggression, hostility, and personality changes, particularly when starting the medication or at higher doses. Watch for differences in mood or behavior, and contact your healthcare provider immediately if you notice any changes.

Rufinamide

Banzel (rufinamide) is indicated as an add-on treatment for LGS in adults and children 1 year and older.

The way rufinamide works in the body is unknown. However, it is thought to act on sodium channels in the brain to reduce overactivity.

Rufinamide comes in tablet or liquid suspension form for oral dosing. Always take your dose with food. Do not take rufinamide if you have a heart condition known as QT prolongation. Rufinamide is also not recommended if you have kidney or liver damage.

Topiramate

Topamax (topiramate) can be used for focal seizures, primary generalized tonic-clonic seizures, or LGS in adults and children 2 years and older.

Topiramate is available as capsules or sprinkle capsules, which can be opened and added to soft food.

Topiramate is a medication that carries a heavy side effect burden, one that may include vision changes, decreased sweating, changes in electrolyte balance in your body, and mood changes. Topiramate is not recommended if you are pregnant or thinking of becoming pregnant.

Valproic Acid

Valproic acid is commonly used to treat absence seizures and complex partial seizures.

Valproic acid has serious side effects that need to be watched for when starting the medication, including liver failure, pancreatitis, and fetal toxicity (harm to the fetus during pregnancy). Because of this, valproic acid cannot be used if you are pregnant or trying to conceive while on it.

Zonisamide

Zonisamide (brand names Zonegran or Zonisade) is used to treat focal seizures. It is available in capsule and liquid formulations.

Zonisamide belongs to a class of medications called sulfonamides. It is important to let your healthcare provider know if you develop any sudden rashes or trouble breathing while taking zonisamide, as it can be a sign of a serious allergic reaction.

Common Side Effects of AEDs

AEDs may also carry the risk of behavioral and mood changes, such as increased aggression, irritability, or depression.

Having an open discussion with your healthcare provider about the risks of your medication is important. Mental changes should be closely watched for when first starting treatment. Immediately contact your healthcare provider if you notice any mood or behavior changes.

Other common side effects related to AEDs include:

• Drowsiness

• Fatigue

• Dizziness

• Blurry vision

• Incoordination

• Cognitive problems
  

Which AED Is Right For Me?

Your healthcare provider will work with you to decide on the best treatment. Certain factors may play a role in this decision, including:

• Side effects: Some AEDs may carry a heavier side effect burden than others.

• Pregnancy: Some AEDs, like valproic acid, carry a higher risk of causing adverse effects to the fetus during pregnancy. Lamotrigine, levetiracetam, and oxcarbazepine have the lowest risk.

• Dosing: AEDs may have different dosing schedules or forms. If you struggle to remember to take your medication, a once-daily option may be best for you.

• Other medications: Other medications you take may affect how your body absorbs certain AEDs.

• Kidney and liver function: Certain AEDs can affect your kidney and liver function and may not be the best choice if you have impaired function. These include valproic acid, phenytoin, and felbamate.

Summary

There are two main types of epilepsy medications: narrow-spectrum AEDs and broad-spectrum AEDs. Different types of these medications are available for different types of seizures. Depending on your condition and other factors, your healthcare provider will work with you to find the best option.

If you've been prescribed a new medication, discuss the risks and benefits with your healthcare provider.

Frequently Asked Questions

What epilepsy medication has the fewest side effects?

All medications can potentially cause side effects. However, certain medications, such as levetiracetam, may have fewer side effects than others. All AEDs can potentially affect your mood or behavior, so watch for any of these changes.

Before starting treatment, talk to your healthcare provider about the specific side effects of your medication.

How will my healthcare provider choose which epilepsy medication to prescribe?

Your healthcare provider will choose certain medications depending on what type of epileptic disorder you have. Other factors may come into play, such as whether you experience any side effects, if you're pregnant or plan to become pregnant, and other health conditions, such as liver or kidney problems.

Are anti-epileptics and anticonvulsants the same thing?

All medications used to treat seizures, epilepsy, and convulsions can be listed as anti-epileptic drugs. However, depending on the type of seizure disorder you have, the treatment will be different.

Read the original article on Verywell Health.