For 70% of patients with epilepsy, drugs can control seizures. However, they can't cure epilepsy, and most people will need to continue taking medications.
An accurate diagnosis of the type of epilepsy [not just the type of seizure, because most seizure types occur in different types of epilepsy] a person has is very important in choosing the best treatment. The type of medication prescribed will also depend on several factors specific to each patient, such as which side effects can be tolerated, other illnesses they may have, and which delivery method is acceptable.
Below is a list of some of the most common brand-name drugs currently used to treat epilepsy. Your doctor may prefer that you take the brand name of anticonvulsant and not the generic substitution. Talk with your doctor about this important issue.
Brivaracetam [Briviact]
- Approved for use as an add-on treatment to other medications in treating partial onset seizures in patients age 16 years and older.
- Possible side effects include drowsiness, dizziness, fatigue, nausea and vomiting.
Cannabidiol [Epidiolex]
- Approved in 2018 for treatment of severe or hard-to-treat seizures including those in patients with Lennox-Gastaut syndrome and .
- Common side effects include lethargy, sleepiness, fatigue, increased appetite, diarrhea and sleep disorders.
Carbamazepine [Carbatrol or Tegretol]
- For partial, generalized tonic-clonic and mixed seizures
- Common adverse effects include fatigue, vision changes, nausea, dizziness, rash.
Cenobamate [Xcopri]
- For use in adults with partial onset seizures
- Common side effects include insomnia, dizziness, fatigue, diplopia, and headache were most common in trials
Diazepam [Valium], lorazepam [Ativan] and similar benzodiazepine tranquilizers such as clonazepam [Klonopin]
- Effective in short-term treatment of all seizures; used often in the emergency room to stop a seizure, particularly status epilepticus
- Tolerance develops in most within a few weeks, so the same dose has less effect over time.
- Valium can be given orally, as an injection, in an IV or as a rectal suppository.
- Side effects include tiredness, unsteady walking, nausea, depression, and loss of appetite. In children, they can cause drooling and hyperactivity.
Eslicarbazepine [Aptiom]
- This drug is a once-a-day medication used alone or in combination with other anti-seizure drugs to treat partial-onset seizures.
- The most common side effects include dizziness, nausea, headache, vomiting, fatigue, vertigo, ataxia, blurred vision, and tremor.
Ethosuximide [Zarontin] Felbamate [Felbatol] Fenfluramine [Fintepla] Lacosamide [VIMPAT] Lamotrigine [Lamictal] Levetiracetam [Keppra]
- It is combined with other epilepsy drugs to treat partial seizures, primary generalized seizures and myoclonic [shock-like jerks of muscle] seizures.
- Side effects include tiredness, weakness, and behavioral changes.
Oxcarbazepine [Oxtellar XR, Trileptal]
- Used to treat partial seizures, it is a once-daily medicine used alone or with other medications to control seizures.
- Common side effects include dizziness, sleepiness, headache, vomiting, double vision, and balance problems.
Perampanel [Fycompa]
- The drug is approved to treat partial onset seizures and primary generalized tonic-clonic seizures in those age 12 and older.
- The label carries a warning of potential serious events including irritability, aggression, anger, anxiety, paranoia, euphoric mood, agitation, and changes in mental status.
Phenobarbitol
- Oldest epilepsy medicine still in use. It is used to treat most forms of seizures and is known for its effectiveness and low cost.
- Side effects can be sleepiness or changes in behavior.
Phenytoin [Dilantin] Pregabalin [Lyrica] Tiagabine [Gabitril] Topiramate [Topamax]
- Used with other drugs to treat partial or generalized tonic-clonic seizures. It is also used with absence seizures.
- Side effects include sleepiness, dizziness, speech problems, nervousness, memory problems, visions problems, weight loss.
Valproate, valproic acid [Depakene, Depakote]
- Used to treat partial, absence, and generalized tonic-clonic seizures
- Common side effects include dizziness, nausea, vomiting, tremor, hair loss, weight gain, depression in adults, irritability in children, reduced attention, a decrease in thinking speed. Over the long term, the drug can cause bone thinning, swelling of the ankles, irregular menstrual periods. More rare and dangerous effects include hearing loss, liver damage, decreased platelets [clotting cells], and pancreas problems.
- Should not be taken if pregnant.
Zonisamide [Zonegran]
- Used with other drugs to treat partial, generalized and myoclonic seizures
- Adverse effects include drowsiness, dizziness, unsteady gait, kidney stones, abdominal discomfort, headache, and rash.
Other drugs used for seizures include clobazam [Onfi], gabapentin [Neurontin], primidone [Mysoline], rufinamide [Banzel], stiripentol [Diacomit], and vigabatrin [Sabril].
Epilepsy Drug Guidelines
It may take several months before the best drug and dosage are determined for you. During this adjustment period, you will be carefully monitored through frequent blood tests to measure your response to the medication.
It is very important to keep your follow-up appointments with your doctor and the lab to minimize your risk for serious side effects and prevent complications.
When seizures continue despite treatment for epilepsy, it may be because the episodes thought to be seizures are non-epileptic. In such cases, you should get a second opinion from a specialist and have EEG-video monitoring so the diagnosis can be re-evaluated.
In specialized centers, about 15% to 20% of patients referred for persistent seizures that defy treatment ultimately prove to have non-epileptic conditions.