Anticonvulsants

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)
Originally released June 12, 2009; last updated June 23, 2016; expires June 23, 2019

Overview

The term "anticonvulsant" is applied to a drug used for the treatment of epileptic seizures, hence, the synonym "antiepileptic.” Anticonvulsants are also being used in the treatment of neuropathic pain and as mood stabilizers in the treatment of psychiatric disorders such as bipolar disorder. In this article, the author reviews anticonvulsants as a drug class and their use in conditions other than epilepsy, such as pain and psychiatric disorders. The author also compares the mechanism of action as well as the efficacy of various anticonvulsants.

Key points

 

• A number of drugs with different mechanisms of action have anticonvulsant properties and are used as antiepileptics.

 

• Some of the approved anticonvulsant drugs have been investigated for relief of pain and psychiatric disorders and some of these indications are approved.

 

• Several clinical trials of anticonvulsant drugs are still ongoing.

 

• The use of anticonvulsants should be personalized to increase efficacy and safety by matching the right drug to the right patient.

Historical note and terminology

The term "anticonvulsant" is applied to a drug used for the treatment of epileptic seizures, hence, the synonym "antiepileptic,” which is often denoted by the abbreviation AED. This term is applied to other agents such as ketogenic diet and procedures such as vagal nerve stimulation when used for control of seizures. Some drugs from other pharmacological categories have anticonvulsant effect, eg, acetazolamide, which is a carbonic anhydrase inhibitor. Anticonvulsants are also being used in the treatment of neuropathic pain and as mood stabilizers in the treatment of psychiatric disorders such as bipolar disorder.

The era of anticonvulsant drugs started with the introduction of bromides in 1857 and was followed by the discovery of the anticonvulsant effect of barbiturates in 1912 (Hauptman 1912). Phenytoin (diphenylhydantoin), synthesized in 1908, was not introduced for the treatment of epilepsy until 1938 (Merritt and Putnam 1938). Although carbamazepine was shown to have antiepileptic properties in 1954, it was first approved in 1968 for the treatment of trigeminal neuralgia and was approved in 1974 for the treatment of epilepsy. Anticonvulsant properties of valproic acid, which is structurally unrelated to other antiepileptic drugs, were discovered by chance in 1963; however, it did not become a major anticonvulsant drug until the 1970s. Older anticonvulsant drugs with new variations are still widely used and remain the mainstay for treatment of epilepsy in developing countries. During the past 2 decades, several new anticonvulsant drugs have been approved worldwide, and the use of anticonvulsant drugs in indications other than epilepsy has increased. Several new drugs are in development. Currently approved anticonvulsants include the following:

 

(1) Carbamazepine
(2) Clobazam
(3) Diazepam
(4) Eslicarbazepine acetate
(5) Ethosuximide
(6) Ezogabine (retigabine)
(7) Felbamate
(8) Fosphenytoin
(9) Gabapentin
(10) Lacosamide
(11) Lamotrigine
(12) Levetiracetam
(13) Oxcarbazepine
(14) Perampanel
(15) Phenobarbital
(16) Phenytoin
(17) Pregabalin
(18) Primidone
(19) Rufinamide
(20) Stiripentol (approved in the European Union for Dravet syndrome)
(21) Sulthiame (not available in the United States but registered in other countries)
(22) Tiagabine
(23) Topiramate
(24) Valproic acid
(25) Vigabatrin
(26) Zonisamide

Several anticonvulsant drugs are reviewed individually in other clinical summaries. This article compares various anticonvulsants and describes their uses for other indications besides epilepsy.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.