Anticonvulsants FAQs: Understanding Your Medication

Anticonvulsants are a group of medications that are commonly referred to as antiseizure medications, antispasmodics, and antiepileptic drugs. These are medications that are used to prevent or cope with already happening seizures.

Primarily, the medications are used for epilepsy but they are also effective in any other condition that is associated with seizures such as:
- Eclampsia;
- Drug intoxication;
- Tetanus;
- Alcohol or drugs withdrawal syndrome, and others.

Besides, anticonvulsants are used for the treatment of bipolar disorder because some of the formulations from this group have a mood-stabilizing activity.

First of all, you need to get a precise diagnosis from your doctor. If you have any type of cramps or seizures, you should be checked for epilepsy and if your healthcare provider decides that you need anticonvulsants, you will be given a prescription.

This is a neurological disease with a focus in the brain. The typical symptoms of the disease are repeating seizures. The causes of seizures are short failures in regular brain activity. Seizures can be generalized, i.e. full-body seizures, or partial that affect a certain body part.

Seizures can be of different type either generalized (total-body) or partial.

Generalized seizures are classified into absence seizures and tonic-clonic seizures. Partial seizures also called focal seizures; they appear in a limited area of the brain rather than the whole brain.

Usually, epilepsy symptoms occur in childhood. Although sometimes it can start to manifest later in life but that doesn’t mean that you got it at that time. The disease isn’t contagious. It is either a genetically transmitted disorder or a secondary disorder resulting from a brain injury, infection, stroke, and so on.

Status epilepticus is an emergency condition that manifests in a seizure that lasts for thirty minutes or more. If an individual has a seizure for five minutes or starts developing a new convulsion without fully recovering from the first one, emergency help is needed.

When seizure control with medications isn’t implemented, the condition can be indeed life-threatening. For instance, status epilepticus can develop or a person can drown or get into a car accident during a seizure.

Around 60% of people who are using correctly chosen and adjusted anticonvulsant therapy experience normal life without seizures. Other individuals can start having much fewer seizures with the use of medications but not fully get rid of them.
Besides, there are certain epilepsy types, for instance, rolandic epilepsy, which occurs in childhood and can be out-grown.

There are certain circumstances that can trigger a seizure. They include stress, fear, fever, menstruation, alcohol consumption, flashing lights, and many others. But it not necessary that all of these factors are active triggers, i.e. for one person they can be potent triggers while others are not sensitive to them.

No, it is a misconception about epilepsy. In fact, it is more dangerous to put something in the mouth of a person who has a seizure because it can cause an injury.

Diagnosis of epilepsy usually includes a set of procedures starting from a doctor’s examination of a patient, blood test, to electroencephalography, computed tomography and/or magnetic resonance imaging. These methods help a doctor to identify the cause of seizures, as well as classify seizures.

The treatment depends on multiple factors identified during diagnosis establishment:
- A suitable medication is chosen by a doctor based on the type of epileptic seizures, patient’s age, sex, and other factors. A doctor should also take into account the financial capabilities of the patient. Only a doctor can choose the right drug, but the patient's opinion should also be taken into account when choosing a therapy.
- It is preferable to use monotherapy, i.e. a single drug use. Patients with the first established disorder are usually treated with a single drug. Based on the properties of the medication, the dosage is gradually raised till the effective one. The maximum dosage of a certain drug for an individual patient is chosen on personal tolerance. If the maximum tolerable dosage doesn’t render the desired effect, a doctor can choose another medication. Combination therapy, i.e. when several anticonvulsants are taken, is used only after several failed attempts of monotherapy because the use of a single medication is, in general, better tolerated and suitable for long-term treatment.
- Certain medications require a very slow rise of the dosage. In such cases, the initial dosage can be quite far from the optimal dosage that will provide the desired effect.
- Average duration of the therapy is from two to five years after the stopping of attacks. The efficiency of the therapy is assessed based on the lack of seizures and normalization of the data obtained from electroencephalogram. In 70% of patients, the correctly chosen therapy leads to the elimination of seizures. The maintenance use of anticonvulsants is made under a doctor’s supervision and with regular checkups.
- The discontinuation of the therapy is made under a doctor’s supervision. A patient must never adjust the dosages or quit using the medication without following their doctor’s instructions. The withdrawal is usually made with a gradual reduction of the dosage over a month or up to one year.
- A treated patient is recommended to normalize sleep and wakefulness regimen and lead a generally healthy lifestyle.

The medications start rendering a steady and equal effect once they are accumulated in the bloodstream. Different medications have a different time they need to start rendering an anticonvulsant effect but none of them have an instant effect.

There are two major groups of anticonvulsants both of which have the same aim – to prevent seizures. One groups acts by reducing excitation while another promotes inhibition of the electrical activity in neurons. The effects are achieved through impacting the ion channels in the cell membrane.

Different medications have different contraindications for use. The most common one is the personal intolerance of the active or auxiliary substances. Besides, some of the anticonvulsants are prohibited to children below a certain age. You need to take every drug in particular and read the instruction.

Any medicinal products can provoke adverse effects occurrence and anticonvulsants are not an exception. The most common adverse effects that usually develop during the first days of the therapy or when the dosage is raised are sleepiness and dizziness. These effects usually disappear over time as your body gets used to the drug.
The potentially harmful adverse effects include allergic reactions that start as a skin itching and rash, swelling, or nausea. To be sure that the medication doesn’t harm your health, report all of the adverse effects you experience to your healthcare provider right away.

There are some of the anticonvulsants that can affect the cognitive functions or a patient may develop this as a reaction to a certain drug that isn’t known to cause this adverse effect. The situation can be changed by switching to another medication chosen by your healthcare provider as a response to your complaints.

If you missed the dosage, you should take it immediately as you remembered because the effect of anticonvulsants is due to the accumulated effect and maintained level of the medication in the body. However, you should not take a double dosage if it’s already time for the next intake unless your healthcare provider tells you to do so.

If you vomit within an hour or two after you have taking the pill, you need to take the dosage again because there is a high chance that it had been washed out of your body. But if vomiting occurred within three or more hours, there is no need to take the recoup dosage because the taken one had already absorbed.

No. The medications from this group do not cause dependence. However, you can be using other medications for epilepsy or accompanying conditions such as antidepressants that can cause addiction.

Yes, if you need to take other medications you can take them but you need to consult your healthcare provider first because some drugs can influence the effect of anticonvulsants or vice versa.

- Some of the anticonvulsants including Carbamazepine, Phenytoin, Phenobarbitone, Primidone, and others, when taken with oral birth control minimize their effect. Thus, you need to consult a specialist on other birth control methods.
- In some women who receive hormone replacement therapy it positively affects seizures, i.e. lowers their frequency. But in some, it, on the contrary, lowers the effect of anticonvulsants so you have to consult a doctor first.
- Some antidepressants and antipsychotics can enhance seizures or their frequency.
- Some medications used for malaria are incompatible with antiepileptic medications and are contraindicated for people with epilepsy.
- NSAIDs can negatively interact with Phenytoin.

One of the manifestations of epilepsy called status epilepticus that is characterized by either prolonged seizures (more than 5 minutes) or repeated seizures without the patient’s full recovery from the previous. This condition requires emergency measures. Thus, people history of status epilepticus must have emergency medications at hand at all times. Such medications include Midazolam pills dissolving between the gum and the cheek, Midazolam nasal formulation, or rectal suppositories with Diazepam that allow stopping an extended seizure quickly.

Although you can drink alcohol in small amounts while undergoing antiepileptic therapy, you should be careful because it can cause a faster washing out of the medications from the body and increase the likelihood or frequency of seizures.

Some medications such as Carbamazepine can cause sexual dysfunctions. If you develop it, you should consult your doctor on how to cope with it - ask for a changed therapy, or lowering of the dosages.

Women with epilepsy who want to get pregnant or are already pregnant must consult their healthcare provider on the changes to their therapy. Anticonvulsants must be taken during gestation as otherwise seizures can severely damage the woman and her unborn baby but the therapy may be needed to be changed significantly and only a specialist can do it.

If you want to quit you therapy, you should know that it can lead to a significant worsening of the condition and even status epilepticus (prolonged seizures that require emergency help). You must consult your doctor and quit a certain medication that you are using only when the next one is chosen by your doctor and with a gradual lowering of the current drug.

The most commonly used and prescribed anticonvulsants today are:
- Phenytoin, Lamotrigine and Phenobarbital. They inhibit the release of glutamate from the endings of the excitatory neurons, thereby preventing the activation of neurons of the epileptic focus.
- Valproic acid and some other antiepileptic drugs, according to modern concepts, are antagonists of NMDA receptors of neurons and interfere with the interaction of glutamate with NMDA receptors.
- Benzodiazepines and Phenobarbital interact with the GABA-A receptor complex. The allosteric changes of the GABA-A receptor, which occur in this case, increase its sensitivity to GABA and even greater entry of chlorine ions into the neuron, which as a result counteracts the development of depolarization.
- Tiagabin is a GABA reuptake blocker from the synaptic cleft. The stabilization of this inhibitory mediator in the synaptic cleft is accompanied by potentiating of its interaction with GABA-A receptors of neurons of the epileptic focus and the strengthening of the inhibitory effect on their excitability.
- Vigabatrin (an inhibitor of GABA transaminase) - blocks GABA catabolism and increases its content in the endings of inhibitory nerve cells.
- Gabapentin has the ability to enhance the formation of GABA. The mechanism of its antiepileptic action is also due to the ability to directly open channels for potassium ions.
- Carbamazepine, Valproate and Phenytoin by Sun Pharma alter the inactivation of potential-dependent sodium and calcium channels, thereby limiting the spread of electrical potential.
- Ethosuximide blocks T-type calcium channels.