Which medications in the drug class Anticonvulsants are used in 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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Anticonvulsant agents, including lamotrigine, levetiracetam, oxcarbazepine, topiramate, and valproic acid, are commonly used for the treatment of seizures. Initial treatment includes monotherapy. Newer agents are acceptable choices and are likely just as effective as older agents.

Lamotrigine (Lamictal, Lamictal XR, Lamictal ODT)

Lamotrigine is a triazine derivative that inhibits the release of glutamate and voltage-sensitive sodium channels, leading to stabilization of the neuronal membrane. Lamotrigine is indicated for both adjunctive treatment and monotherapy for epilepsy.

Oxcarbazepine (Trileptal)

The pharmacological activity of oxcarbazepine is primarily by the 10-monohydroxy metabolite (MHD) of oxcarbazepine. It may block voltage-sensitive sodium channels, inhibit repetitive neuronal firing, and impair synaptic impulse propagation. This drug's anticonvulsant effect may also occur by affecting potassium conductance and high-voltage activated calcium channels.

Carbamazepine (Tegretol, Tegretol XR, Epitol, Carbatrol)

Carbamazepine has anticonvulsant actions that may involve depressing activity in the nucleus ventralis anterior of the thalamus, resulting in a reduction of polysynaptic responses and blocking posttetanic potentiation. It reduces sustained high-frequency repetitive neural firing. It is indicated for partial seizures, generalized tonic-clonic seizures, and mixed seizures.

Topiramate (Topamax, Topiragen, Topamax Sprinkles)

Topiramate is a sulfamate-substituted monosaccharide with a broad spectrum of antiepileptic activity that may have a state-dependent sodium channel blocking action, potentiation of the inhibitory activity of the neurotransmitter gamma-aminobutyrate (GABA), and, possibly, blocking of glutamate activity. Topiramate is indicated for both adjunctive treatment and monotherapy for epilepsy.

Levetiracetam (Keppra)

Levetiracetam may inhibit presynaptic calcium channels by binding to a synaptic vesicle glycoprotein, SV2A. Levetiracetam is rapidly and almost completely absorbed after oral intake, with peak plasma concentrations approximately 1 hour after oral administration. It is predominantly excreted unchanged through the kidneys, with only about 27% metabolized.

Valproic acid (Depakote, Depakene, Depacon, Depakote ER, Stavzor)

Valproic acid is chemically unrelated to other drugs used to treat seizure disorders. Although its mechanism of action is not established, the activity of valproic acid may be related to increased brain levels of GABA or enhanced GABA action. This agent may also potentiate postsynaptic GABA responses, affect potassium channels, or have a direct membrane-stabilizing effect.

Phenytoin (Dilantin, Phenytek, Dilantin Infatabs)

Phenytoin may act in the motor cortex, where it may inhibit the spread of seizure activity. The activity of brain stem centers responsible for the tonic phase of grand mal seizures may also be inhibited. The dose administered should be individualized.

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