From the Guidelines
There is no significant difference between anti-epileptic drugs and anti-seizure medications; these terms are generally used interchangeably. Both refer to medications used to prevent or control seizures in people with epilepsy or other seizure disorders, as noted in the recent clinical policy update by the American College of Emergency Physicians (ACEP) in 2024 1. Common examples of these medications include:
- Carbamazepine (Tegretol)
- Valproic acid (Depakene)
- Levetiracetam (Keppra)
- Phenytoin (Dilantin)
- Lamotrigine (Lamictal) These medications work by various mechanisms to stabilize electrical activity in the brain, reducing the likelihood of seizures. The choice of medication depends on the type of seizures, patient characteristics, and potential side effects. According to the ACEP clinical policy, first-line treatment for recurrent seizures is the appropriate dosing of benzodiazepines, with second-line treatment including agents such as phenytoin, levetiracetam, and valproic acid 1.
It's essential to consider the potential complications of noncompliance with antiseizure drug therapy, which can make patients more likely to present to the emergency department with seizures 1. Additionally, prescribed and illicit substance use can lower the seizure threshold, making management more challenging. The recent ACEP clinical policy update highlights the importance of careful consideration in the management of adult patients presenting to the emergency department with seizures, including the use of anti-seizure medications 1. Patients should never stop or change their anti-epileptic/anti-seizure medication regimen without consulting their healthcare provider, as sudden changes can trigger seizures.
From the Research
Definition and Terminology
- The terms "antiepileptic," "anticonvulsant," and "antiseizure" have been used to describe medications for seizure disorders 2.
- The International League Against Epilepsy (ILAE) recommends using the term "antiseizure medications" to describe these agents, as it accurately reflects their primarily symptomatic effect against seizures 2.
- Antiepileptic drugs (AEDs) and anti-seizure medications (ASMs) are often used interchangeably, but the term "antiseizure" is preferred as it reduces the possibility of undue expectations or incorrect understanding of the real action of these medications 2.
Differences and Similarities
- Both AEDs and ASMs are used to treat epilepsy and seizure disorders, with the primary goal of eliminating seizures while minimizing adverse effects 3, 4.
- The choice of medication depends on several factors, including the type of seizures, the patient's age, general health, and potential drug interactions 3, 4, 5.
- There are various AEDs and ASMs available, with different mechanisms of action, efficacy, and safety profiles 3, 4, 6, 5.
Treatment and Management
- Pharmacotherapy is the most important pillar in the treatment of epilepsies, with approximately 50% of patients requiring combination treatment with multiple ASMs 6.
- The knowledge of specific drug interactions in combination therapies is essential to recognize and avoid adverse side effects 6.
- Therapeutic drug monitoring in serum is not necessary for all ASMs, but should be used rationally and consistently if indications are present 6.