1. The Side Effects of Anti-Epileptic Drugs
S E Essex Epilepsy Support group meeting
Dr Ann Cheesman
Neurology, Southend Hospital
14th March 2017

2. Numbers of People with Epilepsy
Southend Hospital serves a population of 340,000 people
Number of new people with epilepsy in UK : 50 per 100,000 per year
→ over 150 new patients per year in Essex region
Number of people with epilepsy: cases per 1000 equates to cases
We have 700 Epilepsy FU patients
ie are in Primary Care

3. Starting medication
After 2 epileptic seizures separated by < 10 years
(unless there are precipitating factors unlikely to be repeated)
After the first seizure if there are likely to be further seizures
eg. seizure several months after a traumatic brain injury
Discuss risks and benefits
Need a margin of protection

4. Actions of antiepileptic drugs
GOOD
Controlling seizures
Some: reduce anxiety
Some: help migraine
UNWANTED
SIDE EFFECTS
Dizziness
Drowsiness
Weight gain

8. Choosing a drug The right drug for the type of epilepsy
Avoid drugs with difficult S/Es for this patient
eg Topiramate in a person with depression
eg Sodium Valproate in an overweight person
Are there S/Es which would be useful?
eg Topiramate in a person with migraine
eg Topiramate in an overweight person

9. Women & Epilepsy Drugs: issues
Contraception:
Lamotrigine reduces Oestrogen levels from the pill
Foetal malformations:
Increased with multiple medications and higher doses
AVOID Valproate unless essential
Pregnancy:
Folic Acid 5mg od throughout fertile years
Continue medication
Lamotrigine may need to be increased
Child cognition
Dose-related reduction in IQ with Valproate
UK Epilepsy and Pregnancy Register

10. Major congenital malformation rate (%) by drug dose.
 Major congenital malformation rate (%) by drug dose. CBZ, carbamazepine; LTG, lamotrigine; VPA, valproate.
Morrow J et al. J Neurol Neurosurg Psychiatry 2006;77:
©2006 by BMJ Publishing Group Ltd

11. Foetal valproate syndrome

12. How do drug levels vary in the blood?
American Epilepsy Society 2011

13. Side Effects Acute: Chronic: “Out of the blue”:
related to the drug levels eg. max an hour after drug
Reversible- go away when the drug is stopped
Chronic:
Related to chronic use
Reversible or irreversible
“Out of the blue”:
Bone marrow effects

14. Acute Side Effects
Rash
10% with Lamotrigine
Blurred vision
Tiredness

15. Nerves - sensation and balance
Longterm Side Effects
Bone including vitamin D
Carbamazepine/Oxcarbazepine
Phenytoin
Sodium Valproate
Gum and skin changes
Phenobarbital
Nerves - sensation and balance
Carbamazepine

16. Bone Side Effects
Ask whether you should be on Vitamin D?

17. Gum Side Effects
Mainly Phenytoin
Need folic acid

18. Nerves
Balance- reversible except mainly Phenytoin

22. Thank you!
… Any questions?

23. Drug choices Carbamazepine, Oxcarbazepine
Sodium channel inhibition
Carbamazepine, Oxcarbazepine
Lamotrigine (+ glut reduction)
Topiramate (+ glut reduction & CACN moduln)
Phenytoin
Lacosamide- need ECG
GABA augmentation
Sodium valproate
Clobazam, Lorazepam
Phenobarbital
Synaptic vesicle protein modulation
Levetiracetam
(Ca channel modulation)
Gabapentin, Pregabalin
AMPA receptor antagonist Inhibits fast glutamate post-synaptic excitation
Perampanel