Anticonvulsants/Antiepileptic ; The Latest Classification

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Anticonvulsants (also commonly known as antiepileptic drugs or as antiseizure drugs) are a diverse group of pharmacologicalagents used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder and borderline personality disorder,since many seem to act as mood stabilizers, and for the treatment of neuropathic pain.Anticonvulsants suppress the excessive rapid firing of neurons during seizures. Anticonvulsants also prevent the spread of the seizure within the brain.

Seizure types 

  • Absence seizures (including typical and atypical absences):
    Acetazolamide , Clonazepam , Ethosuximide , Lamotrigine , Sodium valproate
  • Atonic seizures:
    Phenobarbital , Phenytoin , Primidone , Sodium valproate
  • Catamenial seizures (menstrual-related):
    Acetazolamide , Clobazam
  • Cluster seizures:
    Clobazam
  • Episodic disorders:
    Acetazolamide
  • Dravet syndrome (severe myoclonic epilepsy in infancy or SMEI):
    Stiripentol
  • Focal (partial) seizures:
    Acetazolamide , Carbamazepine , Clobazam , Clonazepam , Eslicarbazepine acetate , Gabapentin, Lacosamide , Lamotrigine , Levetiracetam , Oxcarbazepine  Perampanel , Phenobarbital , Phenytoin , Pregabalin  Primidone | Retigabine | Sodium valproate  Tiagabine , Topiramate,  Vigabatrin,  Zonisamide
  • Focal (partial) seizures with secondary generalisation:
    Gabapentin , Lacosamide , Levetiracetam , Perampanel , Phenobarbital , Phenytoin , Pregabalin, Primidone , Retigabine , Sodium valproate , Tiagabine | Topiramate , Vigabatrin , Zonisamide
  • Focal seizures with secondary generalised tonic clonic seizures:
    Carbamazepine , Eslicarbazepine acetate , Lamotrigine , Oxcarbazepine
  • Infantile spasms:
    Nitrazepam , Sodium valproate , Vigabatrin
  • Juvenile Myoclonic Epilepsy (seizures related to)
    Levetiracetam
  • Lennox-Gastaut syndrome (seizures related to)
    Lamotrigine , Rufinamide  Topiramate
  • Menstrual-related (catamenial seizures):
  • Myoclonic seizures:
    Clonazepam , Ethosuximide , Phenobarbital , Phenytoin , Primidone  Piracetam , Sodium valproate
  • Myoclonic seizures in Juvenile Myoclonic Epilepsy
  • Tonic seizures
    Phenobarbital , Phenytoin , Primidone , Sodium valproate
  • Tonic clonic seizures
    Acetazolamide , Carbamazepine , Clobazam , Clonazepam , Eslicarbazepine acetate , Lamotrigine , Phenobarbital , Phenytoin , Primidone , Sodium valproate , Topiramate
  • Tonic clonic seizures in severe myoclonic epilepsy in infancy (SMEI or Dravet syndrome
  • West Syndrome with Tuberous Sclerosis
    Vigabatrin

Benzodiazepines

The benzodiazepines are a class of drugs with hypnotic, anxiolytic, anticonvulsive, amnestic and muscle relaxant properties. Benzodiazepines act as a central nervous system depressant. The relative strength of each of these properties in any given benzodiazepine varies greatly and influences the indications for which it is prescribed. Long-term use can be problematic due to the development of tolerance to the anticonvulsant effects and dependency.Of the many drugs in this class, only a few are used to treat epilepsy:

  • Clobazam (1979). Notably used on a short-term basis around menstruation in women with catamenial epilepsy.
  • Clonazepam (1974).
  • Clorazepate (1972).

The following benzodiazepines are used to treat status epilepticus:

  • Diazepam (1963). Can be given rectally by trained care-givers.
  • Midazolam (N/A). Increasingly being used as an alternative to diazepam. This water-soluble drug is squirted into the side of the mouth but not swallowed. It is rapidly absorbed by the buccal mucosa.
  • Lorazepam (1972). Given by injection in hospital.

Nitrazepam, temazepam, and especially nimetazepam are powerful anticonvulsant agents, however their use is rare due to an increased incidence of side effects and strong sedative and motor-impairing properties.

Bromides

  • Potassium bromide (1857). The earliest effective treatment for epilepsy. There would not be a better drug until phenobarbital in 1912. It is still used as an anticonvulsant for dogs and cats.

Carbamates

  • Felbamate (1993). This effective anticonvulsant has had its usage severely restricted due to rare but life-threatening side effects.

Carboxamides 

Carbamazepine

The following are carboxamides:

  • Carbamazepine (1963). A popular anticonvulsant that is available in generic formulations.
  • Oxcarbazepine (1990). A derivative of carbamazepine that has similar efficacy but is better tolerated and is also available generically.
  • Eslicarbazepine acetate (2009)

Fatty acids

  • The valproates — valproic acid, sodium valproate, and divalproex sodium (1967).
  • Vigabatrin (1989).
  • Progabide
  • Tiagabine (1996).

Vigabatrin and progabide are also analogs of GABA.

Fructose derivatives

  • Topiramate (1995).

GABA analogs

  • Gabapentin (1993).
  • Pregabalin (2004).

Hydantoins

The following are hydantoins

  • Ethotoin (1957).
  • Phenytoin (1938).
  • Mephenytoin
  • Fosphenytoin (1996).

Oxazolidinediones

The following are oxazolidinediones:

  • Paramethadione
  • Trimethadione (1946).
  • Ethadione

Propionates

  • Beclamide

Pyrimidinediones

  • Primidone (1952).

Pyrrolidines

  • Brivaracetam
  • Etiracetam
  • Levetiracetam (1999).
  • Seletracetam

Succinimides

The following are succinimides:

  • Ethosuximide (1955).
  • Phensuximide
  • Mesuximide

Sulfonamides

  • Acetazolamide (1953).
  • Sultiame
  • Methazolamide
  • Zonisamide (2000).
Triazines
  • Lamotrigine (1990).

Ureas

  • Pheneturide
  • Phenacemide

Valproylamides

  • Valpromide
  • Valnoctamide

Other

  • Perampanel
  • Stiripentol
  • Pyridoxine

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