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Second-Generation Anticonvulsants

Topiramate (Topamax®) is used with other anticonvulsant drugs in the treatment of partial seizures and generalized tonic-clonic seizures in adults and children aged 2 to 16. Although its precise mechanism of action is unknown, one theory suggests that its anticonvulsant activity may be due in part to increasing GABA (gamma-aminobutyric acid), a neurotransmitter that inhibits excitation of nerve cells in the brain. It is available in oral form, including sprinkles for children, and should be taken twice daily.

Major side effects include drowsiness, nausea, dizziness, and coordination problems. Children may have difficulty concentrating and may become agressive. Acute glaucoma and visual abnormality, a potentially very serious complication, has been reported in a small number of patients. If any abnormal visual symptoms occur, patients should notify their physician immediately. There are few drug interactions between Topamax® and other medications or other anticonvulsants.

Gabapentin (Neurontin®) is indicated for the adjunctive treatment of partial seizures, with or without secondary generalization. Although it is structurally related to the substance GABA (gamma-aminobutyric acid), it does not interact with GABA receptors in the brain, and its mechanism of action is unknown. It is available in oral form and should be taken three times daily.

No laboratory monitoring of liver, kidney, or hematologic (blood) function is necessary with Neurontin®. Its major side effects are fatigue, dizziness, and imbalance. Neurontin® also has been used successfully in patients with neuropathic pain syndromes.

Lamotrigine (Lamictal®) is used for the adjunctive treatment of partial seizures. Its precise mechanism of action is unknown. It is presently available in oral form. Lamictal® should be taken twice daily. No laboratory monitoring of Lamictal levels are necessary. Its major side effect is the appearance of a potentially life-threatening skin rash, particularly for patients who also are taking valproate (Depakote®). Any patient taking Lamictal who develops a rash should immediately report it to his or her physician. Other side effects include headache, nausea, and dizziness.

Tiagabine (Gabitril®) is indicated for adjunctive therapy in adults with partial seizures. Its mechanism of action may be related to its effect on the brain substance GABA (gamma-aminobutyric acid). It is available in oral form and should be given in divided doses two to four times daily. No laboratory monitoring of Gabitril levels are necessary. Some interaction likely exists when Gabitril is taken with other anticonvulsants, in that its metabolism may be altered. Side effects include dizziness and somnolence.

Keppra® (levetiracetam) Keppra is approved for use in adults as adjunctive therapy for the treatment of partial seizure disorders. The side effects can include fatigue, imbalance and behavioral changes, which often dissipate after the first month of treatment.

Trileptal® (oxcarbazepine) is indicated for monotherapy (used alone) in adults who have partial seizures and can be used in children as add-on therapy for partial seizures. The most common side effects include dizziness, sleepiness, nausea, and imbalance, but these do not warrant clinical observation.

Zonegram (Zonisamide) is approved for use in adults as adjunctive therapy for partial seizures. It has however, been used fairly extensively in other countries for use in other seizure types including generalized seizures, myoclonic seizures and absence seizures. Side effects can include dizziness, imbalance and fatigue. Individuals who are allergic to sulfonamide drugs should not use Zonisamide since it is a derivative of this class of drug

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