What is the safety and tolerability of anticonvulsants for the treatment of first adult seizure?

Updated: Nov 30, 2017
  • Author: Eissa Ibrahim AlEissa, MD, MBBS; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Although phenytoin, carbamazepine, valproate, and phenobarbital were initially reported as equally effective in treating newly diagnosed epilepsy, phenobarbital had more adverse effects. [46] In general, barbiturates should be avoided because of neurotoxic and cognitive side effects. [8]

Overall, the newer antiepileptic drugs appear safer and better tolerated; however, they have not been used for as long or in as many patients as the older drugs. None of the common side effects of the older drugs (eg, gum hyperplasia, neuropathy) have been identified; however, ruling out potential new problems with long-term use of the newer antiepileptic drugs is difficult. Head-to-head studies have demonstrated favorable side effect profiles for gabapentin when compared with carbamazepine, and for oxcarbazepine and lamotrigine when compared with both phenytoin and carbamazepine.

All newer antiepileptic drugs, although "officially" approved as adjunctive therapy, are acceptable options for monotherapy (off-label use).

Privitera et al found topiramate 100 mg/d is as effective as therapeutic doses of carbamazepine and sodium valproate and has the fewest discontinuations due to adverse events. [51]


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