<p></p><p>Anti-epileptic drugs (AED) and anti-convulsant drugs are most
prescribed by neurologists for the treatment of seizures and epileptiform
discharges.</p>

<h1>Generic AED names with&nbsp;brand names</h1>

<h4>Carbamazepine&nbsp;also available as&nbsp;Carbagen,&nbsp;Tegretol,&nbsp;Tegretol
Prolonged Release</h4>

<p>Carbamazepine is a favorite partial seizure medicine in the developed world. Carbamazepine affects
sodium channels, and inhibits rapid firing of brain cells. Long-acting forms
such as Carbatrol or Tegretol-XR can be given once a day. Potential side
effects include GI upset, weight gain, blurred vision, low blood counts, low
blood sodium (hyponatremia). Carbamazepine causes a rash rate of a few percent,
sometimes even the dangerous rash called Stevens-Johnson syndrome. People of
Asian descent with HLA-B*1502 antigen are more at risk. Typical adult dose is
400 mg tid.&nbsp;</p><p>This is a good choice of AED for slow alpha variants.</p><h3>Figure xx: Image of Tegretol pills and chemical bond</h3><p><img src="@@PLUGINFILE@@/carb.jpg" alt="carb" width="300" height="436" class="img-responsive atto_image_button_left"><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><h4><br></h4><h4>Benzodiazepines and EEG Effects</h4>

<p>Benzodiazepines produce a spindling, sinusoidal hyper-rhythmic 18-25Hz pattern. They also decrease alpha.&nbsp;<span style="font-size: 1rem;">Sometimes this pattern is more pronounced in the front of the head, but the
pattern can be seen globally.&nbsp;</span><span style="font-size: 1rem;">Dosing and systemic vascularity of the being will alter the
expression of how the drug will appear.</span></p><p></p><h4>Figure xx: Image of Benzodiazepine Toxicity in EEG. Image generated from Neuroguide version
3.0.6.</h4><br><p></p><img src="@@PLUGINFILE@@/benzos.png" alt="EEG of Benzos" width="925" height="979" class="img-responsive atto_image_button_text-bottom"><br><p></p>

<p><!--[if !supportLists]-->·&nbsp; &nbsp; &nbsp;&nbsp;</p><h3>Figure xx: Image of
Benzodiazepine Toxicity in a Linked Ears Montage. Image generated from
Neuroguide version 3.0.6.</h3><p><img src="@@PLUGINFILE@@/benzos%202.png" alt="benzos 2" width="714" height="943" class="img-responsive atto_image_button_left"><br></p><p></p>

<p><!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p></p><h3>Figure 5: Image of
Benzodiazepine Toxicity in individual Hertz bins (linked ears montage). Image
generated from Neuroguide version 3.0.6.</h3><p><img src="@@PLUGINFILE@@/benzo3.png" alt="benzo3" width="714" height="361" class="img-responsive atto_image_button_left"><br></p><br><p></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><img src="@@PLUGINFILE@@/benzo4.png" alt="benzo4" width="718" height="360" class="img-responsive atto_image_button_left"><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><p><br></p><h3>More Anti-Convulstants</h3>

<h4><a href="https://www.medicines.org.uk/emc/search?q=%22Gabapentin%22" target="_blank">Gabapentin</a>&nbsp;also available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=neurontin" target="_blank">Neurontin</a></h4>

<p><p>This is often used as a secondary
anticonvulsant to boost GABA.&nbsp;<span style="font-size: 1rem;">Gabapentin
has the reputation of being a safe but not particularly powerful AED. The
effectiveness criticism probably is because it is often prescribed at too low a
dose. The drug probably works by influencing transport of GABA and effects on
calcium channels. It has no drug interactions, is not metabolized in the liver
and it does not bind to blood proteins. Side effects are unsteadiness, weight
gain, fatigue, dizziness. Typical adult dose is 300-600 mg three times a, but
doses can be up to 1200 mg three times a day.</span></p><h3><span style="font-size: 1rem;">Figure xx: Image of Neurontin Pills</span></h3></p><p><img src="@@PLUGINFILE@@/neurontin.jpg" alt="Neurontin" width="531" height="385" class="img-responsive atto_image_button_left"></p>

<h4><a href="https://www.medicines.org.uk/emc/search?q=lacosamide" target="_blank">Lacosamide</a>&nbsp;available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=lacosamide" target="_blank">Vimpat</a></h4>

<p>&nbsp;Lacosamide is a new (2009) antiepileptic drug
, for partial and secondarily generalized seizures. It is chemically related to
the amino acid, serine. Vimpat blocks sodium channels (but in a different way
from other seizure medicines), and this block reduces brain excitability. Side
effects include dizziness, headache, nausea or vomiting, double vision,
fatigue, memory or mood problems. Vimpat may affect the internal organs, blood
counts or heart rhythm, but these potentially serious side effects are
infrequent. The recommended starting dose is 50 mg twice daily, increased each
week by an extra 100 mg, to the recommended maintenance dosage of 100-200 mg
twice a day.&nbsp;</p><p><br></p>

<h4>Figure xx: Image of Lamictal Pills</h4><p><img src="@@PLUGINFILE@@/lamictal.jpeg" alt="lamictal" width="400" height="400" class="img-responsive atto_image_button_left"></p><h4>&nbsp;<a href="https://www.epilepsysociety.org.uk/lamotrigine">Lamotrigine</a>&nbsp;also available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=Lamotrigine" target="_blank">Lamitcal</a></h4><p>A broad-spectrum alternative to VPA, with a better side effect profile. However, LTG may not be as effective for myoclonic seizures. Lamotrigine works by several mechanisms including blocking release of glutamate, the brain’s main excitatory neurotransmitter. It has the usual side effects of dizziness and fatigue, usually mild cognitive (thinking) impairment. Severe medical side effects are unusual. The practical side effect issue is rash, occurring in several percent of people who take it, especially if the dose is increased too fast. Therefore, it takes a couple of months to get up to the typical adult dose of 200 mg twice a day.&nbsp;</p><p>This is the best option for an EEG when the individual has a normal
peak frequency alpha.</p><br><p></p>

<h4>&nbsp;</h4><h4><br></h4><h4><a href="https://www.epilepsysociety.org.uk/levetiracetam">Levetiracetam</a>&nbsp;also available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=%22Levetiracetam%22" target="_blank">Desitrend</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=%22Levetiracetam%22" target="_blank">Keppra</a></h4>

<p><img src="@@PLUGINFILE@@/keppra.jpg?time=1588884706231" alt="keppra" width="300" height="200" class="img-responsive atto_image_button_left">Levetiracetam is one of the more
used medicines in seizure clinics because it probably is effective for a
broad-spectrum of seizures types, has a relatively low incidence of causing
thinking/memory problems, and can be started at 500 mg twice a day, which is an
effective dose. It has no drug interactions, is not metabolized in the liver
and it does not bind to blood proteins. The most common side effects are
dizziness, fatigue, insomnia, but the more troublesome problem can be
irritability and mood changes. This may occur to some degree in up to a third
of those taking the medicine. A typical adult dose is 500 - 1500 mg twice a
day. This is best for epileptic findings that are temporal
and generalized.</p><h3>Figure xx: Image of Keppra</h3><h4>Lorazepam (Ativan)</h4>

<p>Lorazepam is similar to clonazepam
in dosage and action, but it is not as long-acting. It is usually used as a
‘rescue medication’ for patients who frequently have clusters of seizures. Best used<span style="font-size: 1rem;">&nbsp;for status epilepticus or very short-term management, as it is highly addictive and has dependency&nbsp;</span>potential.&nbsp;It
works reasonably quickly when taken orally and anti-seizure effect lasts for
2-6 hours. Typical adult dose is 0.5-2.0 mg orally or as needed.&nbsp;</p><h4>Figure xx: Image of Lorazepam (Ativan)</h4><p><img src="@@PLUGINFILE@@/Ativan.jpg" alt="Ativan" width="300" height="300" class="img-responsive atto_image_button_left"><br></p>

<h4><a href="https://www.medicines.org.uk/emc/search?q=%22Oxcarbazepine%22" target="_blank">Oxcarbazepine</a>&nbsp;also available as <a href="https://www.medicines.org.uk/emc/search?q=%22Oxcarbazepine%22" target="_blank">Trileptal</a></h4>

<p>Slightly different from
carbamazepine, it is at least as effective, and may have fewer side effects,
except for more risk for low blood sodium (hyponatremia). It is more expensive
than generic carbamazepine. A typical adult dose is 600 mg twice a day.</p><p><img src="@@PLUGINFILE@@/ox.jpg" alt="ox" width="224" height="224" class="img-responsive atto_image_button_right"><br></p>

<h4>·&nbsp;</h4><h4><br></h4><h4><a href="https://www.medicines.org.uk/emc/search?q=%22Phenobarbital%22" target="_blank" style="font-size: 1.286rem; background-color: rgb(255, 255, 255);">Phenobarbital</a><span style="font-size: 1.286rem;">&nbsp;also available as Luminal</span><br></h4>

<p>The old-timer: very inexpensive and
effective in a single daily dose. Phenobarbital increases the effect of GABA,
the main inhibitory neurotransmitter in the brain. Watch for sedation,
thinking/memory problems and depression. Phenobarbital can cause long-term bone
problems. Phenobarbital is mildly addictive and requires slow withdrawal.&nbsp;</p><p><img src="@@PLUGINFILE@@/phenobarbital.jpg" alt="phenobarbital" width="259" height="194" class="img-responsive atto_image_button_left"><br></p>

<h4>&nbsp;<!--[endif]--><a href="https://www.epilepsysociety.org.uk/phenytoin">Phenytoin</a>&nbsp;also available as<a href="https://www.medicines.org.uk/emc/search?q=phenytoin" target="_blank">&nbsp;Epanutin</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=phenytoin+sodium+flynn" target="_blank">Phenytoin
Sodium Flynn</a>, Dilantin</h4>

<p>The most used AED by general
physicians in the US, less so by epilepsy doctors, because of the side effects.
Phenytoin alters brain cell sodium channels, which has the effect of limiting
<img src="@@PLUGINFILE@@/dilantin.jpg" alt="dilantin" width="200" height="200" class="img-responsive atto_image_button_right">rapid firing of the brain cells. It is inexpensive. Common side effects are
unsteadiness and moderate cognitive problems. There are long-term potential
cosmetic (body/face hair growth, skin problems), and bone problems
(osteoporosis). Phenytoin causes a rash rate of a few percent, sometimes even
the dangerous rash called Stevens-Johnson syndrome. Typical adult dose is
300-400 mg per day, usually with 100 mg pills.</p>

<h4>·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]--><a href="https://www.medicines.org.uk/emc/search?q=pregabalin&amp;offset=1&amp;limit=50&amp;orderBy=company&amp;refreshFilters=true" target="_blank">Pregabalin</a>&nbsp;also available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=pregabalin&amp;offset=1&amp;limit=50&amp;orderBy=product&amp;refreshFilters=true" target="_blank">Alzain</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=axalid" target="_blank">Axalid</a>,<a href="https://www.medicines.org.uk/emc/search?q=pregabalin&amp;offset=1&amp;limit=50&amp;orderBy=newest&amp;refreshFilters=true" target="_blank">&nbsp;Lecaent</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=lyrica" target="_blank">Lyrica</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=pregabalin&amp;offset=1&amp;limit=50&amp;orderBy=product-desc&amp;refreshFilters=true" target="_blank">Rewisca</a></h4>

<p>A relative of gabapentin, it may be
better, and can be given twice a day. Some believe that it is more effective
against seizures than is gabapentin. Pregabalin has no drug interactions, no
liver metabolism, no protein binding, and similar side effects to gabapentin.
Typical adult dose is 150 - 600 mg bid.&nbsp;</p>

<h4>·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]--><a href="https://www.medicines.org.uk/emc/search?q=rufinamide" target="_blank">Rufinamide</a>&nbsp;available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=rufinamide" target="_blank">Inovelon</a>, Banzel</h4>

<p>Banzel is approved for add-on treatment of
children age 4 and older and adults with&nbsp;<a href="https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs">Lennox
Gastaut Syndrome</a>. This syndrome can include seizure types such
as atonic (drop) seizures, tonic (stiffening) seizures, myoclonic (brief
jerking) seizures, or staring (absence) seizures, as well as partial seizures.
Banzel works on sodium channels in brain cells, in a way to make them less
excitable. Common side effects include headache, dizziness, fatigue and
sleepiness, double vision and tremor (trembling). People who have the “short QT
syndrome,” a rare heart rhythm irregularity, should not take Banzel. The drug
comes as 200 and 400 mg tablets.</p>

<h4>·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]--><a href="https://www.epilepsysociety.org.uk/topiramate">Topiramate</a>&nbsp;also available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=%22Topiramate%22" target="_blank">Topamax</a></h4>

<p>A good broad-spectrum AED (i.e.,
treats all types of seizures). Topiramate has several mechanisms, including
blocking the enzyme carbonic anhydrase, which affects the acidity of brain
tissue. More acidity (to a point) suppresses seizures. Side effects include thinking
and memory problems in about 1/3rd, renal stones in 1-2%, rare cases of
glaucoma (increased eye pressure) and weight loss. Typical adult dose is
150-200 mg twice a day.&nbsp;</p>

<h4>·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]--><a href="https://www.medicines.org.uk/emc/search?q=%22valproic+acid%22" target="_blank">Valproic
acid</a>&nbsp;available as<a href="https://bnf.nice.org.uk/drug/valproic-acid.html#indicationsAndDoses" target="_blank">&nbsp;Depakote,
Convulex</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=%22valproic+acid%22" target="_blank">Epilim
Chrono</a>,&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=%22valproic+acid%22" target="_blank">Epilim
Chronosphere</a></h4>

<p>This is the standard broad-spectrum
AED (treats all types of seizures) and no other AED is more effective for
generalized seizure types. VPA has effects on GABA (at least in very high
doses), and a neurotransmitter called NPY to block seizures, and maybe also on
calcium channels. VPA has significant side effects: weight gain, tremor, hair
loss, GI upset, blood count decreases, hepatic or pancreatic injury, bone
weakness over time (osteoporosis), birth defects in up to 10% (folic acid can
help to prevent them). Typical adult dose is 250 mg - 500 mg three times a day,
but dose can be higher.&nbsp;</p>

<h4>·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]--><a href="https://www.medicines.org.uk/emc/search?q=%22vigabatrin%22" target="_blank">Vigabatrin</a>&nbsp;available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=%22vigabatrin%22" target="_blank">Sabril</a></h4>

<p>At time of this writing, vigabatrin
is approved in the US, but official package insert information has not become
available. Vigabatrin is a “designer drug,” made to block metabolism of GABA,
the brain’s main inhibitory neurotransmitter. Sabril has been used for over a
decade in many countries, and it is effective for partial seizures, with or
without secondary generalization. It also may be very effective for infantile
spasms, a serious type of seizures in young children. Release in the US was
delayed because the drug is toxic to the retina of the eye in up to 30% of
people who take it long-term. This toxicity can result in permanent loss of
peripheral vision. Regular vision testing is recommended for all people on this
drug. A typical regimen begins with 500 mg twice a day, and can increase over a
month or two to 1500 mg twice a day.&nbsp;</p>

<h4>·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<!--[endif]--><a href="https://www.medicines.org.uk/emc/search?q=zonisamide" target="_blank">Zonisamide</a>&nbsp;also available as&nbsp;<a href="https://www.medicines.org.uk/emc/search?q=zonisamide" target="_blank">Zonegran</a></h4>

<p>Zonisamide is rather similar in its
coverage and side effects to topiramate, except glaucoma is not usually listed.
Some find less cognitive impairment than with topiramate but this is individual
and dose-dependent. Typical adult dose is 100-300 mg twice a day.</p><br><p></p>