Brent asked
What are the most common medications used for partial seizures in children 10 years of age? Which have the least side effects?
Answer
There are many different drugs that can be used for partial seizures. Drug choice typically depends on the type of partial seizure the patient is experiencing.
There are various classifications and guidelines for partial seizures. Typically, there are 3 recognized types of partial seizures:
Simple Partial: Simple partial seizures are characterized by a preservation of consciousness of the individual. Typically these seizures involve one or two body parts and last for 20-60 seconds.
Complex Partial: These are characterized by impaired consciousness of the patient with the seizures lasting 30 seconds to 2 minutes. It is often associated lip smacking or hand wringing.
Partial with Secondary Generalized Tonic-Clonic: These seizures start out as a simple or complex partial seizure and evolve into a tonic-clonic seizure (whole body seizure) with a loss of consciousness. These typically last 1-2 minutes.
The type of medication given depends on the type of seizure. As a first line treatment, you would probably see one of five medications:
- Carbamazepine
- Phenytoin
- Oxcarbazepine
- Phenobarbital
- Valproic Acid
Other options, while typically not first line, are:
- Primidone
- Gabapentin
- Topiramate
- Tiagabine
- Zonisamide
Of course, the ideal anti-seizure drug suppresses all seizure activity without causing any side effects. Unfortunately, many of the drugs fail to adequately control the seizures fully and they do tend to frequently cause unwanted effects that can range from extremely mild to very serious. It should be noted that EVERY anti-seizure medicine, as required by the FDA, includes a warning about an increased risk of suicidal thoughts or actions.
Every patient is different in terms of how they will respond to a given anti-seizure drug. It has been reported that about 50% of patients can achieve complete control of their seizures while the others can attain partial control. Most physicians try to only have their patient on one drug in order to minimize side effects. If the one drug isn't effective, patients typically will go on multi-drug therapy.
I will talk about the most common side effects of popular drugs but by all means, if you have a drug in mind in which you would like a detailed explanation, please send it our way.
Phenytoin: This drug can often cause some unwanted adverse reactions. The good thing about this drug though, is that it does NOT tend to cause sedation or drowsiness. Some of the side effects patients should know about are
GI discomfort
Headache
Gingival hyperplasia (overgrowth of the gums) - This can actually happen quite often and emphasis should be placed on good personal oral hygiene and gum massage. Dental plaque may contribute to hyperplasia. Patients should be encouraged to see a dental professional regularly for monitoring.
Rash
Hirtuism (hair growth) - Can be a huge concern in females
Vitamin D deficiency
Phenobarbital: This drug is actually typically well tolerated but does sometimes cause significant sedation
Sedation and drowsiness are the most common side effects
Rashes
Carbamazepine/Oxcarbazepine (Trileptal):
Headache
Drowsiness
Psychiatric effects (confusion, anxiety etc.)
GI discomfort
Skin reactions
Valproic Acid (Depakote):
Nausea is by far the most common side effect
Sedation
Rash
Stimulation of appetite (weight gain)
As I mentioned before, if you have any specific questions or a drug in which you want more information, let us know!
In terms of which medication has the least side effects, that is tough to say as everyone responds differently to medications. I would say the "safer" medications are phenobarbital and valproic acid. They still cause side effects but they tend to be to a lesser degree and less often. Many of the side effects of the other medications can be well controlled with proper dose adjustment.
