Antiepileptica

Antiepileptica, or antiepileptic drugs (AEDs), are a diverse group of medicines used to prevent, reduce, or control seizures in people with epilepsy. They are also used for other conditions such as neuropathic pain and mood stabilization in bipolar disorder.

Most AEDs act by modulating neuronal excitability through various mechanisms, including blockade of voltage-gated sodium channels (for example carbamazepine, phenytoin, lamotrigine), enhancement of GABAergic inhibition (benzodiazepines, phenobarbital), modulation of calcium channels (ethosuximide for absence seizures), inhibition of excitatory glutamatergic transmission, or binding to the synaptic vesicle protein SV2A (levetiracetam).

Common AEDs include valproate, carbamazepine, phenytoin, lamotrigine, levetiracetam, oxcarbazepine, topiramate, gabapentin, pregabalin, and ethosuximide. They are used to treat focal (partial) seizures and generalized tonic–clonic seizures; ethosuximide and valproate are also effective for absence seizures. Dosing is individualized, often starting at a low level and titrating slowly, with attention to drug interactions, pregnancy considerations, and comorbidities.

Monitoring and safety considerations vary by drug but may include liver function tests or drug level measurements. Some AEDs carry teratogenic risks (valproate has well-documented concerns for fetal development), and others can cause side effects such as drowsiness, dizziness, cognitive changes, rash (notably lamotrigine), or, rarely, liver injury or hypersensitivity. Long-term treatment aims to achieve seizure control with the lowest effective dose while minimizing adverse effects; abrupt withdrawal is avoided to reduce relapse risk.

For refractory epilepsy, nonpharmacologic options such as ketogenic diet, responsive neurostimulation, or epilepsy surgery may be considered. Medication choices should be individualized by clinicians based on seizure type, comorbidities, and potential interactions.