Convulsions, or seizures, are classified as partial seizures or generalized seizures. Partial seizures generally involve only one side of the brain, while generalized seizures typically involve both sides of the brain and may affect consciousness. Generalized seizures may be further classified as absence, myoclonic or tonic-clonic. Many medications are effective in treating these convulsive disorders. Discuss your options and any concerns with a health care professional.
Carbamazepine and Oxcarbazepine
Carbamazepine is available in immediate release form as the brand names Carbatrol and Tegretol, and in extended release form as Tegretol XR. The medications are available in capsule, suspension and tablet form. Carbamazepine is the drug of choice in the treatment of partial seizures in any age group. Oxcarbazepine (Trileptal) is indicated for the treatment of partial seizures in adults and in children older than 4, either alone or in addition to other anticonvulsants. It is also a potential medication of choice in those with primary generalized seizures. Furthermore, "oxcarbazepine may be effective in patients not demonstrating a response to carbamazepine," according to the book "Pharmacotherapy: A Pathophysiologic Approach."
Phenobarbital
Phenobarbital is the drug of choice for neonatal seizures, reports "Pharmacotherapy: A Pathophysiologic Approach." Significant side effects of phenobarbital included delayed intellectual development and hyperactivity in children and significant cognitive impairment in adults. Therefore, physicians reserve phenobarbital for patients who are not well controlled on other anticonvulsants.
Phenytoin
Phenytoin, the generic of Dilantin, is the medication of choice for partial seizures and tonic-clonic seizures. It is available is injection form as well as in oral form via capsules, suspension and tablets. According to the "Drug Information Handbook," phenytoin is not indicated in infants younger than 6 months. Fosphenytoin (Cerebryx) is a newer medication that converts to phenytoin in the body. A major advantage of fosphenytoin is that it can be administered at a quicker rate; this is important when seizures must be controlled quickly. However, fosphenytoin costs more than phenytoin and is only available as an injection.
Lamotrigine
Lamotrigine is the generic of Lamictal preferred for the treatment of partial seizures and as an alternative for generalized seizure treatment. It is available in tablet form and approved for anyone over the age of 2. Lamotrigine has FDA approval for standard treatment of partial seizures. This medication causes less sedation and less cognition impairment than phenobarbital, reports "Pharmacotherapy: A Pathophysiologic Approach."
Valproic Acid
Valproic acid has two derivatives: divalproex sodium and valproate sodium. Valproic acid and its derivatives can treat both partial and generalized seizures. They work the same way in the body and have the same efficacy. According to "Pharmacotherapy: A Pathophysiologic Approach," valproic acid or a derivative causes less impairment of cognition than other medications such as phenytoin and phenobarbital. The brands Depakene capsule and Depakene syrup contain valproic acid. Depakote tablets, Depakote ER tablets and Depakote sprinkles are the brands of divalproex sodium. The injection form is Depacon or valproate sodium.
Other Anticonvulsants
Ethosuximide, or the brand Zarontin, is standard treatment for absence seizures and is available in capsule and syrup form. "This drug is very effective in the treatment of absence seizures. It is generally well tolerated and has few interactions," reports the book "Pharmacotherapy: A Pathophysiologic Approach." Gabapentin, the generic of Neurontin, is used as an alternative for treatment of partial seizures in adults and in children older than 3 who are not well controlled on standard treatment. Levetiracetam, the generic of Keppra, is indicated for treatment of partial seizures in individuals who have not demonstrated an improvement on standard therapy. It is also used as an alternative treatment for generalized seizures. Topiramate (Topamax) is used when patients are not well controlled on the preferred therapy for partial seizures; it's also an alternative treatment for myoclonic seizures.
References
- "Drug Information Handbook 15th Edition"; Charles F. Lacy, RPh, PharmD, FCSHP, Lora L. Armstrong, RPh, PharmD, BCPS, et al; 2007
- "Pharmacotherapy: A Pathophysiologic Approach"; Joseph T. Dipiro, Robert L. Talbert, et al; 2008
Member Comments