Timothy J. Ainger, PhD, FAES

You've been called to evaluate someone with a new diagnosis of epilepsy. Now you need to decide what kind of antiseizure drug (ASD) to recommend. Start Keppra and be done with it? We can put a little more thought into it than that! Why can it be so challenging to pick an appropriate ASD for someone? There's a number of factors that have to go into it! 🧠 Type of epilepsy/seizures/syndrome present 😵‍💫Possible side effects ↔️ Med interactions 💵 Cost of meds 🧠 Type of Epilepsy or Seizures Broadly speaking we think of 2 kinds (this is a very simplified approach ok?) 1. Focal 2. Generalized This determines if we're looking at broad spectrum or narrow spectrum meds. Broad spectrum can be used for both generalized and focal onset seizures Some examples include: 1. Valproic acid 2. Zonisamide 3. Topiramate 4. and yes...Levetiracetam (aka Keppra) Narrow spectrum includes meds primarily for focal onset seizures. A few examples being: 1. Phentyoin 2. Carbamazepine 3. Oxcarbazepine 4. Pregabalin 😵‍💫Side Effects These can be broad ranging and many antiseizure drugs have unique profiles of things to watch out for. A common grouping of symptoms for many of them is "dizzy, drowsy, drunk" Which is to say imbalance, sedation, ataxia are common to many seizure meds. Other side effects that can be common include rashes. In the future we'll break down the different families of ASDs and talk more about their unique characteristics. ↔️ Interactions Many ASDs have interactions in the liver, classically the CYP450 pathway. We tend to think of interaction with other ASDs, but they can affect different blood thinners or other meds that go through the pathway. Broadly we think of inducers and inhibitors Inducers: 1. Phenytoin 2. Phenobarbital 3. Carbamazepine Inhibitor: 1. Valproic acid There are other ASDs that have effects on these pathways, but there are a few of the classics. 💵 Cost of meds It should come as no surprise that brand name drugs are more expensive than generic meds in the US. What may surprise you is that many ASDs have an extended release (XR/ER) form, and while the regular release may be generic, sometimes the XR is still branded. It's always important to check to see if the cost of the med you're prescribing is going to be possible for the person to afford. We'll continue running through some principles of prescribing ASDs and specific med quirks throughout the month. Check back next week when @rohitmarawar and I discuss the evaluation for a 1st seizure! nitter.gq/i/spaces/1rmGPMd… And in the meantime you can listen to us talking about selecting ASDs on @neuro_podcast here: buzzsprout.com/1953070/episo…