From anticonvulsants to antiseizure medications: The evolving language of epilepsy treatment

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For decades, neurologists have prescribed pharmacologic therapies to manage epilepsy, but the terminology used to describe these treatments has shifted considerably over time. What were once called “anticonvulsants” became “antiepileptic drugs” and are now increasingly referred to as “antiseizure medications.”

This evolution in language is not merely academic—it reflects changing scientific understanding, improved precision in communication, and renewed focus on the mechanisms and limitations of epilepsy treatments.

A timeline of terminology: from convulsions to seizures to epilepsy

The language we use for seizure medications has always mirrored our conceptual understanding of epilepsy:

Late 19th to early 20th century: "anticonvulsants." The earliest term used to describe pharmacologic treatment was “anticonvulsant.” This label arose when drugs were chosen based on their ability to suppress visible convulsions—most notably, generalized tonic-clonic seizures. Bromides, introduced in the 1850s, and later barbiturates (eg, phenobarbital, 1912), were used empirically to reduce seizure frequency. The term “anticonvulsant” emphasized symptomatic control but did not distinguish between seizure types or address disease mechanisms.

Linguistic aside. Bromides were not just the first antiseizure drugs— the term “bromide” came to symbolize a stale or clichéd idea, especially in politics and public life. In this way, the legacy of early epilepsy treatment lingers in the idioms of social commentary.

Mid-20th century: "antiepileptic drugs." With the introduction of phenytoin (1938), primidone (1952), carbamazepine (1962), and valproic acid (1967), seizure medications gained broader scientific legitimacy. As understanding of epilepsy improved, these drugs came to be called “antiepileptic drugs,” suggesting they targeted the disease itself.

The term “antiepileptic drug,” or “AED,” became standard in research, clinical trials, regulatory documents, and medical education. It reflected the belief—often implicit—that epilepsy was a disease that could be “treated” or “suppressed” by pharmacologic means.

21st century: "antiseizure medications." By the early 2000s, it was increasingly clear that these drugs do not alter the natural course of epilepsy. They suppress seizures while being taken, but they rarely prevent epileptogenesis or induce remission. When discontinued, seizures often recur. The drugs are symptom-suppressing, not disease-modifying.

In 2014, the International League Against Epilepsy Commission on Classification and Terminology formally recommended replacing “antiepileptic drug” with “antiseizure medication” (Scheffer et al 2014). This was reaffirmed in the 2017 ILAE epilepsy classification update (Fisher et al 2017).

Why the terminology matters

This progression in terminology is more than just semantic—it has direct implications for clinical accuracy, patient education, and research strategy.

• Scientific clarity. “Antiseizure medication” emphasizes what these drugs do: suppress seizures. It avoids the misleading connotation that they treat the underlying disorder.
• Patient communication. Telling patients they're taking an “antiepileptic” drug may imply a cure or preventive effect. “Antiseizure” sets more realistic expectations.
• Research alignment. Differentiating symptomatic treatments (antiseizure medications) from potential disease-modifying therapies helps shape clinical trial endpoints and funding priorities.

Clinical practice: where do we stand now?

The term “antiseizure medication,” or “ASM,” has gained widespread adoption in epilepsy research, academic writing, and clinical guidelines. Journals like Epilepsia and Neurology now favor the term, and organizations like the American Epilepsy Society have followed suit in educational content.

Still, “antiepileptic drug,” or “AED,” remains prevalent in older literature and is commonly used in daily clinical practice, particularly among clinicians trained before the 2010s. The term “anticonvulsant” also persists—particularly in pharmacologic package inserts and insurance formularies—creating potential for confusion.

Neurologists navigating these terms should be aware of their historical and conceptual implications. When possible, using “antiseizure medication” fosters greater precision and reinforces a shared understanding of current treatment limitations.

Looking forward: terminology for the next generation

As epilepsy care moves beyond seizure suppression—with trials of gene therapy, anti-inflammatory agents, and targeted disease-modifying interventions—the language will likely evolve again. If treatments emerge that genuinely prevent or reverse epileptogenesis, we will need new terminology to distinguish them from antiseizure medications.

For now, adopting “antiseizure medication” reflects our best current understanding: these drugs suppress seizures, not epilepsy itself.

References

Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014;55(4):475-82. PMID 24730690

Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58(4):512-21. PMID 28276062

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