From the FDA Drug Label
These highlights do not include all the information needed to use GLATIRAMER ACETATE INJECTION safely and effectively. WARNINGS AND PRECAUTIONS • Immediate Post-Injection Reaction (flushing, chest pain, palpitations, tachycardia, anxiety, dyspnea, throat constriction, and/or urticaria), may occur within seconds to minutes after injection and are generally transient and self-limiting (5.1) ADVERSE REACTIONS • In controlled studies of glatiramer acetate injection 20 mg/mL, most common adverse reactions (≥ 10% and ≥ 1.5 times higher than placebo) were: injection site reactions, vasodilatation, rash, dyspnea, and chest pain (6.1)
The FDA drug label does not answer the question.
From the Research
The management of seizure risk in multiple sclerosis patients primarily involves antiepileptic drugs (AEDs) when seizures occur, as there is no standard prophylactic treatment for MS patients without a seizure history. First-line AEDs include levetiracetam (starting at 500mg twice daily, increasing as needed to 1500-3000mg daily), lamotrigine (starting at 25mg daily, gradually titrating to 100-400mg daily), and carbamazepine (starting at 100-200mg daily, increasing to 400-1200mg daily) 1. These medications are preferred due to their favorable side effect profiles and limited interactions with MS disease-modifying therapies. Treatment should continue for at least 2 years after the last seizure before considering discontinuation. For MS patients, it's essential to address potential seizure triggers, including:
- Fever
- Infection
- Sleep deprivation Regular monitoring of electrolytes, particularly sodium levels, is recommended as hyponatremia can lower seizure threshold 2. Clinicians should also be aware that some MS medications like interferon beta may slightly increase seizure risk in susceptible individuals. The underlying mechanism connecting MS and seizures involves inflammatory demyelinating lesions, particularly those in cortical and juxtacortical regions, which can serve as epileptogenic foci by disrupting normal neuronal signaling 3. Recent studies have shown that levetiracetam may be a suitable alternative to carbamazepine and lamotrigine for the treatment of partial onset seizures, and lamotrigine, levetiracetam, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures 1, 2. However, the choice of AED should be individualized based on the patient's specific needs and medical history, and clinicians should be aware of the potential for drug resistance and the need for combination therapy in some cases 4, 5. In summary, the most effective approach to managing seizure risk in MS patients involves the use of first-line AEDs, such as levetiracetam, lamotrigine, and carbamazepine, and addressing potential seizure triggers and underlying mechanisms.