What medications are used to manage nocturnal seizures?

From the Guidelines

Levetiracetam is a medication that can be used to help control seizures that occur during sleep, with a recommended dose of 30 mg/kg i.v. every 12 hours or an increase in the prophylaxis dose by 10 mg/kg (to 20 mg/kg) i.v. every 12 hours (maximum dose of 1,500 mg) 1. When considering medications for nocturnal seizures, it's essential to prioritize those that can provide consistent blood levels throughout the night.

• Extended-release formulations of antiepileptic drugs like levetiracetam (Keppra XR) are beneficial in this context.
• The medication should be timed so that peak levels occur during sleep hours when seizures are most likely.
• Nocturnal seizures often occur during sleep-wake transitions when brain activity changes, and these medications help stabilize neuronal activity during these vulnerable periods.
• It's crucial to take these medications consistently at the same time each day and not to stop them abruptly, as this can lead to withdrawal symptoms or increased seizure activity.
• Side effects may include drowsiness, dizziness, and coordination problems, which are often less problematic when the medication is taken at bedtime. According to the most recent study 1, levetiracetam is a recommended second-line agent for treating seizures refractory to benzodiazepines, further supporting its use in managing nocturnal seizures.

From the Research

Seizure Medications

There are several medications used to treat seizures, including those that occur during sleep. Some of these medications include:

• Carbamazepine, which is effective in treating partial and generalized tonic-clonic seizures 2, 3, 4, 5
• Valproate, which is effective in treating complex partial seizures and secondarily generalized tonic-clonic seizures 4
• Lamotrigine, levetiracetam, perampanel, and topiramate, which have class 1 evidence of efficacy in controlling primarily generalized tonic-clonic seizures (PGTCSs) 6

Medication Efficacy

The efficacy of these medications can vary depending on the type of seizure and the individual patient. For example:

• Carbamazepine is effective in treating generalized tonic-clonic seizures, but may not be as effective in treating complex partial seizures 4
• Valproate is effective in treating complex partial seizures, but may have more adverse effects than carbamazepine 4
• Lamotrigine, levetiracetam, perampanel, and topiramate have been shown to be effective in controlling PGTCSs, but may have different adverse effect profiles 6

Medication Selection

The selection of a medication for treating seizures depends on several factors, including:

• Efficacy, by seizure type 6
• Adverse effects 4, 6
• Interactions with other medications 6
• Adherence and dosing 6
• Mechanism of action 6 It is essential to consider these factors when choosing a medication for treating seizures, especially those that occur during sleep.