AAN Guideline Summary for PATIENTS and THEIR FAMILIES EFFICACY AND TOLERABILITY OF THE NEW ANTIEPILEPTIC DRUGS FOR TREATMENT OF REFRACTORY EPILEPSY
If you or a loved one has epilepsy, this fact sheet will help you and your doctor talk about medicines—called antiepileptic drugs (AEDs)—that offer hope for people with refractory epilepsy. People with refractory epilepsy continue to have seizures, even after trying several medications. This fact sheet is based on the recommendations of a group of experts in neurology and epilepsy who have reviewed all available information on how well the newer antiepileptic drugs work in people who have hard to control seizures. What are seizures?
the new drugs are in the treatment of children and adults
Seizures happen when there are sudden changes in the
with refractory epilepsy. In some cases, there was not
way normal brain cells interact electrically. During a
enough information to decide one way or another.
seizure, a sudden wave of electrical energy swamps partor all of the brain, disrupting normal brain activity. What do the guidelines say?
Consciousness, movement, sensation, speech, mood,
The AAN and AES expert team made recommendations
memory, and emotions can all be affected during the one
for treatment of partial epilepsy—seizures affecting one
area of the brain; generalized epilepsy—seizures affectingthe whole brain, and the Lennox Gastaut syndrome—
What are antiepileptic drugs—or AEDs—and how can they help? Antiepileptic drugs are chemical compounds that affect
The experts did not review the information about the older
the brain. There are more than 20 drugs used in the
drugs, which also can be used to treat many of the conditions
treatment of epilepsy. Antiepileptic drugs do not cure the
discussed in this brochure. Studies have not been done
condition but will often control seizures completely if the
to determine whether the newer drugs could be used in
AEDs are taken regularly. Some AEDs prevent seizures by
all conditions. Even if the experts did not find enough
controlling electrical signals in the brain.
information to recommend the use of one of the drugs, yourdoctor may recommend the AED. The risks, benefits, and
If you have epilepsy, your physician will choose an AED
options for treatment should be discussed with your doctor.
based upon your seizure type, your age, and potential sideeffects. There is often a trial and error period to determine
Partial epilepsy
the best course of therapy for each individual patient.
The experts determined that all the newer antiepilepticdrugs are effective when taken in addition to another
Why did the experts decide to develop new
antiepileptic drug—or add-on therapy—for adults with
guidelines for use of these drugs?
partial seizures. The drug known by its generic name*
Many widely used antiepileptic drugs have been available
gabapentin was found to be effective for the treatment of
for twenty, thirty, and even more than fifty years. Their
mixed seizure. Gabapentin, lamotrigine, oxcarbazepine,
positive and negative effects have been widely studied.
and topiramate were recommended for children with
However, physicians do not know as much about the
refractory partial seizures. In a previous guideline, the
newer antiepileptic drugs that have been approved by the
experts found that felbamate, another new antiepileptic
U.S. Food and Drug Administration over the past ten years.
drug, is also effective in partial seizures. Felbamate hasspecial risks that should be considered by you and your
Neurologists from the American Academy of Neurology (AAN)
doctor before you make a decision to use it.
who specialize in diseases of the brain and central nervoussystem, including epilepsy, and experts in epilepsy from the
The experts who carefully looked at the data wanted to
American Epilepsy Society (AES), believe you should know
determine which of the newer drugs are effective as
about the options for treating and managing your epilepsy. monotherapy—or when taken as a single drug—by peoplewith partial seizures. They concluded that oxcarbazepine,
The experts decided to look carefully at all the currently
topiramate, and possibly lamotrigine are effective in
available information on the new antiepileptic drugs.
preventing refractory partial seizures when taken as
These experts wanted to find out how safe and effective
Generalized epilepsy
The newer AEDs give people with epilepsy the option
When the experts studied the data for generalized epilepsy,
to possibly experience fewer side effects. While all
only topiramate was shown to be effective in people who
medications have some side effects, the choice of which
have been diagnosed with generalized epilepsy and who
drug and which side effects can be tolerated depends on
have not had success with other drug therapies. Studies
the individual person. Your doctor should discuss serious
had not been done for the other drugs.
side effects, if any, when starting any of the newantiepileptic drugs. It is important to discuss possible
Lennox Gastaut syndrome
side effects with your doctor and how willing you are to
People with Lennox Gastaut syndrome have many seizures
each day. These may include drop attacks, in which theindividual experiences a sudden total loss of muscle
What should you know about AED side effects?
control and falls abruptly to the floor. The expert group
Some of the side effects are short term, others continue
recommended that lamotrigine and topiramate may be
as long as the medication is taken. Some side effects may
used to treat drop attacks associated with the Lennox
be linked to dosage—the higher the dose needed to control
Gastaut syndrome in adults and children. In a previous
seizures, the greater the risk of side effects. Side effects
guideline, felbamate was also found to be effective in the
for each AED are different, and most will go away when
Lennox Gastaut syndrome. The special risks of felbamate
the medication is stopped. The newer antiepileptic drugs
(discussed in a previous guideline) should be considered
are in general safer than some of the older ones. You
should ask your doctor if there are any serious sideeffects that might be irreversible. *Glossary of generic to name brand drugs Generic Name Brand
AEDs may affect women with epilepsy in their reproductive
years. Some of the seizure medications available can
decrease the effectiveness of hormone contraception and
some seizure medications can increase the risk of birth
defects. If you are a woman with epilepsy of childbearingage, ask your doctor before you become pregnant about
any safety measures you should consider to minimize
Talk to your neurologist
Together you and your doctor can determine which ofthe many antiepileptic drugs now available will be the
If you have questions about whether you—or your child
safest and most tolerable. Thanks to the new AAN and
—are candidates for any of these medications, ask your
AES guidelines, you and your doctor have more
information from which to make a decision. How will these recommendations affect
It is important that your doctor check your progress at
quality of life?
regular visits, especially during the first few months of
These drugs often enhance the quality of life for people
your treatment with antiepileptic drugs. This will allow
with epilepsy. Antiepileptic drugs can make seizures less
your doctor to adjust your dose, if necessary, and will
frequent or they can help people with epilepsy lead a
help reduce any unwanted side effects.
For further information about epilepsy and its treatment, call 1-800-332-1000 or visit www.epilepsyfoundation.org.
This is an evidence-based educational service of the American Academy of Neurology. It is designed to provide members with evidence-basedguideline recommendations to assist with decision-making in patient care. It is based on an assessment of current scientific and clinical information,and is not intended to exclude any reasonable alternative methodologies. The AAN recognizes that specific patient care decisions are the prerogative of the patient and the physician caring for the patient, based on the circumstances involved. Physicians are encouraged to carefullyreview the full AAN guidelines so they understand all recommendations associated with care of these patients. 342 North Main Street • West Hartford, CT 06117 1080 Montreal Avenue • St. Paul, MN 55116 www.aesnet.org www.aan.com • www.thebrainmatters.org (860) 586-7505 (651) 695-1940
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AAN Guideline Summary for PATIENTS and THEIR FAMILIES
Generalized epilepsy