- Clinical science
Anticonvulsant drugs are classified as either classic or newer anticonvulsants. Newer anticonvulsants are usually better tolerated and have a broader therapeutic range than classic anticonvulsant drugs. The choice of drug is guided by the type of seizure, as not all substances are equally effective in the treatment of all forms of epilepsy. First-line treatment for focal seizures includes e.g., lamotrigine or levetiracetam, while valproate is used for generalized epilepsy. All anticonvulsants have dose-dependent side effects on the central nervous system such as somnolence and nausea, but some agents have more specific side effects (e.g., gingival hyperplasia caused by phenytoin).
Besides their importance in anti-epileptic therapy, anticonvulsants are also used for pain management (e.g., carbamazepine or gabapentin as coanalgesics) or as mood stabilizers in bipolar disorders (valproate).
|Agent||Indication||Mechanism of action||Side effects|
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|Phenobarbital|| || |
|Levetiracetam|| || |
|Gabapentin|| || |
|Pregabalin (tentative FDA approval)|| |
|Vigabatrin|| || |
- Monotherapy should always be the first-line treatment → increase dosage before initiating combination therapy
- Combination therapy: drugs from different classes and/or with different pharmacologic modes of action for refractory seizures
- For more detailed approaches to seizure treatment and epilepsy, see .
Pregnancy and breastfeeding
- Classic anticonvulsants (especially carbamazepine and sodium valproate!) should be avoided if possible → teratogenic effects
- Newer anticonvulsants: lack of medical data and trials during pregnancy
- Choice of treatment depends on type of seizure and which substance enables optimal control of treatment.