anticonvulsivants

Anticonvulsivants, also called anticonvulsants or antiepileptic drugs, are medications used primarily to prevent seizures in epilepsy. They may also treat mood disorders such as bipolar disorder, neuropathic pain, migraine prevention, and, in some cases, restless legs syndrome. These drugs reduce seizure activity by altering neuronal excitability through several mechanisms, including blockade of voltage-gated sodium or calcium channels, enhancement of GABAergic inhibition, and dampening of excitatory glutamatergic transmission. Most anticonvulsivants can be used as monotherapy or as add-on therapy and require gradual dose titration to minimize adverse effects and the risk of seizure worsening during initiation.

Common agents include older drugs such as carbamazepine, phenytoin, phenobarbital, and valproate; and newer or second-generation agents such as lamotrigine, levetiracetam, topiramate, gabapentin, pregabalin, oxcarbazepine, zonisamide, and clobazam. The pharmacokinetic profiles vary: several are hepatic enzyme inducers (e.g., carbamazepine, phenytoin, phenobarbital) which can reduce levels of other medicines, while valproate can inhibit metabolism and cause additive toxicity. Dosing is individualized, and some drugs require monitoring of blood levels or liver function tests.

Safety considerations include teratogenic risk (especially with valproate), sedation, cognitive side effects, dizziness, and allergic reactions such as skin rash. Drug interactions and comorbidities influence choice and dosing. The treatment goal is seizure control with minimum adverse effects, often balancing efficacy, safety, and quality of life across long-term management.