From the Guidelines
Seizures are sudden, abnormal electrical discharges in the brain that can be caused by various factors, and their management typically begins with identifying and treating the underlying cause when possible, with first-line treatment often involving antiepileptic drugs (AEDs) such as levetiracetam, lamotrigine, carbamazepine, or valproic acid, as recommended by the most recent guidelines 1. The causes of seizures can be diverse, including genetic predisposition, brain injuries, infections, stroke, brain tumors, high fever, drug or alcohol withdrawal, and metabolic abnormalities such as low blood sugar or sodium levels. Some key points to consider in the management of seizures include:
- Identifying and treating the underlying cause when possible
- First-line treatment with AEDs such as levetiracetam (Keppra, 500-1500mg twice daily), lamotrigine (Lamictal, 25-200mg twice daily), carbamazepine (Tegretol, 200-400mg twice daily), or valproic acid (Depakote, 250-500mg twice daily) 1
- Lifestyle modifications, including adequate sleep, stress reduction, avoiding alcohol, and identifying personal seizure triggers
- For acute seizures, benzodiazepines like lorazepam (Ativan, 2-4mg IV) or diazepam (Valium, 5-10mg IV) are administered
- Status epilepticus, a prolonged seizure lasting more than 5 minutes, is a medical emergency requiring immediate intervention to prevent neurological damage, as defined by recent clinical policies 1. It's also important to note that anti-seizure medications should not be used as primary prophylaxis among patients with brain metastases, according to current guidelines 1, and that the administration of antiepileptic drugs to patients with brain tumors who have not had seizures is common despite the lack of definitive evidence that the potential benefits might outweigh the side effects of AEDs 1.
From the FDA Drug Label
In patients with epilepsy, a loss of seizure control may also occur.
Antiepileptic drugs, including valproate, may cause suicidal thoughts or actions in a very small number of people, about 1 in 500
Non-psychotic behavioral disorders (reported as aggression and irritability) occurred in 5% of the levetiracetam-treated patients compared to 0% of placebo patients.
Non-psychotic mood disorders (reported as depressed mood, depression, and mood swings) occurred in 6.7% of levetiracetam-treated patients compared to 3.3% of placebo patients.
The causes of seizures are not directly addressed in the provided drug labels. However, the labels do mention that loss of seizure control may occur in patients with epilepsy, and that antiepileptic drugs may cause suicidal thoughts or actions in a small number of people. Additionally, non-psychotic behavioral disorders and non-psychotic mood disorders are reported as potential side effects of levetiracetam treatment.
- Key points:
- Loss of seizure control may occur in patients with epilepsy
- Antiepileptic drugs may cause suicidal thoughts or actions
- Non-psychotic behavioral disorders and non-psychotic mood disorders are potential side effects of levetiracetam treatment
- Seizure management should be carefully monitored in patients taking antiepileptic drugs 2, 2, 3
From the Research
Causes of Seizures
- Seizures can be caused by various factors, including acute illness, brain insult, and genetic disorders 4, 5, 6
- Provoked seizures are treated with relief of the provoking factor, while unprovoked seizures may require antiepileptic drugs (AEDs) 4
- Brain tumors, such as neuroglial tumors and gliomas, can also cause seizures, and tumor-related seizures tend to be resistant to AEDs 7
- Metabolic diseases, toxins, and certain medications can interfere with energy metabolism and cause seizures 5, 6
- Electrolyte imbalance, organ failure, and medication withdrawal can also provoke seizures in medically ill patients 6
Management of Seizures
- Classification of seizure type and epilepsy syndrome is important for guiding initial diagnostic testing and therapy 4
- AEDs are the standard treatment for epilepsy, and selection of the appropriate AED depends on the type of seizure and epilepsy present 4, 8
- Surgery, such as epilepsy surgery or tumor removal, may be necessary for patients with intractable seizures or brain tumors 4, 8, 7
- Vagus nerve stimulator therapy and other treatment options, such as the ketogenic diet, may also be considered for patients with early-onset pediatric epileptic encephalopathies 8
- Careful monitoring of drug levels, liver function tests, complete blood count, and electrolyte levels is highly recommended for patients taking AEDs 8