Anticonvulsants, more accurately called antiseizure medications, are a group of drugs used to help prevent seizures. Doctors may also prescribe some antiseizure medications for anxiety, migraine, and nerve pain.
Antiseizure medications alter electrical activity in the brain to help prevent or stop seizures. A doctor must carefully consider which drug to prescribe, assessing the risk of side effects and how it might work in the body. Someone taking antiseizure medications should also expect to have ongoing monitoring and tests.
This article explores the uses, mechanism of action, and side effects of antiseizure medications.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
This group of drugs was originally called anticonvulsants, but
Epilepsy is a complex group of disorders associated with different types of seizures. Some seizures can be nonconvulsive or convulsive. Jerking movements and a loss of consciousness characterize convulsive seizures.
Sometimes, healthcare professionals may refer to antiseizure medications as antiepileptics or antiepileptic medications.
Learn more about epilepsy.
Antiseizure medications consist of drugs that doctors originally prescribed to treat seizures. However, doctors may prescribe them for other
Some of these are off-label uses of these drugs. Off-label use refers to prescribing medications for a purpose that regulatory bodies, such as the Food and Drug Administration (FDA), have not approved. Still, healthcare professionals can prescribe these medication for off-label use if they believe they may have a positive effect.
Doctors primarily prescribe antiseizure medications to manage epilepsy. Commonly, epilepsy causes seizures.
Antiseizure medications can help manage the following seizure types:
- Convulsive: Jerking movements and a loss of consciousness characterize these seizures. Tonic-clonic seizures are the most common type.
- Nonconvulsive: These are usually more subtle and not associated with jerking movements.
- Focal: Focal seizures usually originate in one part of the brain.
- Generalized: Generalized seizures usually affect both sides of the brain.
The following table lists some examples of antiseizure drugs. Currently, this group of drugs contains more than 20 medications.
| Generic name | Brand name |
| pregabalin | Lyrica |
| clonazepam | Klonopin |
| clobazam | Onfi |
| zonisamide | Zonegran, Zonisade |
| valproic acid | – |
| topiramate | Topamax, Topamax Sprinkle |
| carbamazepine | Tegretol |
| gabapentin | Neurontin |
| phenytoin | Dilantin |
| phenobarbital | Sezaby |
| lamotrigine | Lamictal |
| levetiracetam | Keppra |
When first prescribing antiseizure medications, a doctor may select broad-spectrum options. This type is usually helpful when a doctor cannot classify the type of seizure a person has. Narrow-spectrum antiseizure medications are useful for treating focal or partial seizures.
Learn more about the different types of epilepsy medications.
A mechanism of action refers to how a drug works. The mechanism of action of antiseizure medications can be slightly different for various drugs in this group. Some drugs also work in several ways.
Seizures have associations with various brain receptors, neurotransmitters (chemical messengers), and enzymes.
Experts classify different antiseizure medications based on their main role. Generally, their purpose is to help prevent or stop seizures by altering electrical activity in the brain. Some of their actions include:
- altering electrical activity in nerve cells (neurons) by blocking or stimulating ion channels, such as sodium, calcium, or potassium channels
- increasing activity of neurotransmitters, such as GABA
For some antiseizure medications, the mechanism of action is unknown.
Since antiseizure medications can be effective for treating other conditions, such as anxiety and pain, it is possible that managing these conditions may involve the same receptors, neurotransmitters, and enzymes.
Choosing the right antiseizure medication can be challenging, as there are many factors a doctor must consider. Guidelines for new-onset and drug-resistant epilepsy are available, which can help with this. Additionally, a doctor may consider newer drugs, as they have fewer side effects while being just as effective as older ones.
Other considerations include the type of epilepsy a person has. For example, doctors typically prescribe the following antiseizure medications for partial-onset seizures:
Sometimes, certain antiseizure medications are not suitable for a person.
Contraindications
Another factor to consider, especially in females who can become pregnant or who are actively trying to conceive, is the pregnancy-related risk associated with antiseizure medications. Usually, certain antiseizure medications have
Females who can become pregnant should consider alternative treatment options or ensure they are using effective birth control.
In general, contraindications to certain types of antiseizure medications include:
- history of severe allergic reaction to that medication or any of its ingredients
- liver failure
- specific blood disorders
- narrow angle glaucoma (a rare type of glaucoma)
- short QT syndrome (a rare genetic condition that affects the heart)
People with kidney failure may require adjusted dosing of certain antiseizure medications. Children and older adults may also require similar adjustments.
Drug-drug interactions
Drug-drug interactions are a significant problem with antiseizure medications, particularly older-generation ones. This is because the medications affect liver enzymes and how the body metabolizes (processes) other drugs a person takes.
A person should tell their doctor about any medications they take before starting a new antiseizure medication.
How long a doctor should prescribe antiseizure medications to a person is still unclear. The consensus among neurologists is to stop therapy in children after being seizure-free for
Researchers estimate the risk of seizure recurrence in adults after the 2-year mark at 30%. Guidelines suggest that doctors may discontinue antiseizure drugs in adults if they are seizure-free for 2–5 years.
According to
- headache
- nausea
- fatigue
- dizziness
- blurry vision
- weight changes
- mood disorders
- changes in mental functioning
Still, serious side effects are possible. These may include:
- a severe skin condition known as Stevens-Johnson syndrome
- liver failure
- psychosis
The risk of suicide with antiseizure medications is generally low. However, the FDA requires all antiseizure drugs to carry a warning.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Precautions
Be wary when taking antiseizure medications, as some may have a drowsy effect, affecting a person’s ability to drive or operate heavy machinery. This might be the case if someone is new to the drug or a doctor prescribes a higher dose.
Avoid alcohol consumption in combination with the medication, as it may increase the likelihood of a seizure occurring.
The primary way to treat epilepsy is with medication. However, some complementary alternatives exist.
Some people may benefit from antiepileptic diets. The most common diets for epilepsy are the ketogenic diet and a modified Atkins diet.
It is important to note that the ketogenic diet is very restrictive. It requires a person to eat very few carbohydrates and moderate protein and fat intake. The modified Atkins diet is less limiting than the ketogenic diet. For some people, these alternative treatments do not work.
A person should speak with a doctor before making any changes to their diet, as the doctor may recommend vitamin supplementation.
In some cases, a person’s epilepsy may resist antiseizure therapy. In this case, they may require surgery to help manage their condition. Medication-resistant epilepsy typically requires multidisciplinary treatment.
Certain antiseizure medications require monitoring to measure the amount of the medication present in the blood. Doctors may order blood tests to check this yearly.
A person should speak with a doctor about the
- any side effects that are severe or bothersome
- any concerns about how well the medication is working
- changing doses, frequency, timing, or stopping the medication
Anyone who experiences a seizure or a change in the pattern of seizure requires medical attention.
Antiseizure medications are drugs prescribed to manage seizures. They can also help treat anxiety, migraine, and nerve pain in some people.
Experts have recently changed the term anticonvulsants to antiseizure medications, considering the wide range of medication uses. Various types of antiseizure medications exist, and they work to alter electrical activity in the brain to help prevent seizures. Still, the mechanisms of action of some drugs are unknown.
Antiseizure medications can cause side effects. Commonly, they can lead to headaches, nausea, fatigue, and dizziness. Someone experiencing any side effects or having concerns about the drug should speak with their doctor.