Drug Definitions | Epilepsy and Brain Mapping Program

Tegretol
	Generic Name: Carbamazepine This is one of the most effective medications in treating certain seizure disorders. It has the advantage of having little or no effect on mental abilities for thinking, learning, and general functioning. Side Effects: The most common side effects of this medication more often occur when first beginning the medication. These side effects include nausea, dizziness and unsteadiness. Double vision can also occasionally occur. These symptoms almost always go away after several days to several weeks of being on the medication and you should not be alarmed unless the symptoms persist. To minimize these symptoms Tegretol should be taken with food. Although there are reports that aplastic anemia is a potential side effect of Tegretol, this is extremely rare and probably not different from any other AED. If any effects are seen on the blood count, they are usually a small reversible gradual reduction in the white blood cell count from 5,000 to 3,000. Since white blood cells can fight infection at a level of 1,000, such a decrease is not clinically significant. Occasionally, Tegretol can cause a decrease in the serum sodium level. This is usually only a problem at higher doses and it can cause break through seizures. The condition can be detected easily by a blood sample for electrolytes. Usually the decreased sodium can be corrected by salt tablets, one with each meal or two with each meal or added salt to meals. Other side effects that occur less commonly with Tegretol may include headache, diarrhea or constipation, blurred vision, and difficulty with urination. These symptoms are uncommon and are usually temporary. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. A complete blood count (CBC) and liver function (SGOT) must be checked before Tegretol is started and 3 weeks after. Thereafter levels should be checked every three months for a year then every 6 months. IF THE TEGRETOL LEVEL IS TOO LOW, no symptoms are felt, however, you may experience break-through seizures. IF THE TEGRETOL LEVEL IS TOO HIGH, toxic symptoms may occur. These usually include dizziness, double vision, nausea, loss of appetite and unsteadiness (similar to some of the symptoms felt when first beginning the medication). If these symptoms occur, you should report them to your doctor immediately. If you are experiencing symptoms that may indicate your level is too low or too high, your doctor will have you obtain a lab test to check your Tegretol level. If the level is not therapeutic, he will likely increase or decrease your medication. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician. Drug-to-Drug interactions: While taking Tegretol the following medications should be avoided: Erythromycin, Tagamet (Cimetidine), Darvon and Calan. These medications can cause a rise in the Tegretol level since they inhibit its metabolism and this may result in toxicity. If these medications do need to be taken, consult your doctor so that appropriate dosage adjustments of your Tegretol can be made. Generic forms of Tegretol should not be taken without consulting your physician.
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Dilantin
	Generic Name: Phenytoin, Diphenylhydantoin This is a very effective medication in treating many types of seizures. Dilantin doses have very predictable effects on the blood level (predictable pharmacokinetics). In blood levels up to 20 Dilantin has linear pharmacokinetics, that is to say that one extra 100 mg capsule will produce an increase of 1 in the blood level and that 2 extra capsules will produce an increase of 2 in the blood level. Above a level of 20 Dilantin pharmacokinetics are nonlinear, that is to say that one extra 100 mg capsule can make the Dilantin blood level increase by 2 to 5. When Dilantin levels are high (above 30) it takes longer than usual for the level to come down to normal. Dilantin is as safe in pregnancy as Tegretol so a patient can be on monotherapy (one medication). Dilantin with Folic acid 1 mg daily can be as safe against birth defects as a patient on Tegretol. Side Effects: The most common long-term side-effect of Dilantin is gum irritation and enlargement. This occurs in about 15-20% of patients. Good oral hygiene helps to avoid this problem. We recommend brushing the teeth immediately after each meal and using dental floss each night. We also recommend the use of a Water-pik to flush small particles from below the gumline at bedtime. A new toothbrush known as Interplak, available at the Price Club or at certain pharmacies) is also recommended. This costs about $65-$75. Rarely, Dilantin can cause swelling of the lymph glands and rash. Since these side effects are reversible, your doctor will stop the medication and the problems will go away. Some side effects of Dilantin make it an undesirable AED in childhood. Many children who take Dilantin develop coarser facial features. This is age limited and does not occur in adults. Some adults who take Dilantin develop excess hair growth. This does not occur in all patients and usually, if it occurs, is only complained about by females. Furthermore, it is reversible in adults and therefore if it occurs the patient's medication can be changed to another. Occasionally, Dilantin can cause inflammation of the liver or a decrease in the blood count. For this reason your doctor will periodically check a complete blood count and liver panel. Depending on the individual case this may need to be checked from one to four times per year. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. Dilantin has several unique aspects which make it a popular AED: Dilantin can be taken once a day, say at bedtime, and still have the maximum protective effect against seizures. This is such a convenience, that many professional people prefer to take Dilantin rather than other medications. Dilantin comes in 100 mg and 30 mg capsules and 50 mg chewable tablets. This allows very fine titration (adjustment of dosage to obtain best efficacy - control of seizures - with the least side effects) increasing the benefit/risk ratio. For instance, Mary's seizures are controlled with a level of 20 but she is toxic at a level of 25. If she takes three 100 mg capsules a day (300 mg) her tough level is 16, but if she takes four 100 mg capsules (400 mg) her level is 30. Mary could take three 100 mg capsules and one 30 mg capsule and have a blood level of 22. For another example, John is toxic on 400 mg daily, but he needs a high blood level to control his seizures. He requires fine tuning to 370 mg daily (one 100 mg capsule plus nine 30 mg capsules: 1 x 100 + 9 x 30 = 100 + 270 = 370 ). So by using the 30 mg capsules in various combinations with the 100 mg capsules, John can get the optimum dosage per day to control his seizures without side effects. When all the Dilantin is taken as one dose at night, it is not necessary to get an AM serum trough level before medications early in the morning. So Dilantin levels can be taken when convenient after work. Dilantin is inexpensive. IF THE LEVEL OF DILANTIN IN THE BLOOD IS TOO LOW, no symptoms will be felt by the patient. However, break-through seizures may occur. IF THE DILANTIN LEVEL BECOMES TOO HIGH, you may experience a sense of imbalance as though you are drunk. Dizziness may also be a symptom of DILANTIN toxicity. If these symptoms occur you should contact your doctor immediately.
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Depakote
	Generic Name: Divalproex Sodium This is a very effective medication for certain seizure types and has the advantage of being virtually free of any significant side effects on thinking ability and cognition. Side Effects: When first beginning therapy, patients commonly experience nausea and may experience dizziness or unsteadiness. These side effects are usually temporary and rarely require discontinuation of therapy. A fine tremor of the hand is a common side effect of Depakote and this may persist as long as the patient is taking the medication. It is usually seen only at high doses and generally is not disabling. Weight gain can occur in a small number of patients but this is generally due to an increased appetite rather than a change in metabolism. Rarely, changes in thyroid function can occur. The most serious side effects of Depakote are thrombocytopenia (decrease in blood platelet count), anemia, and inflammation of the liver. These severe problems rarely occur but your doctor will need to check a complete blood count and liver panel periodically. This is checked from two to four times per year in most cases. Depakote can cause thinning of the hair but rarely is it permanent. Depakote can cause problems with liver, however, this is a rare side effect usually seen in young children who are on many other anticonvulsant medications. Depakote is associated with a 1% to 2% occurrence of spina bifida and meningomyelocele in the offspring of mothers with epilepsy. Although this is a significant added risk to the usual 2% occurrence of malformations during any pregnancy and is a reason why other medications are sought for women who want to become pregnant, nevertheless, if a mother has seizures which require the use of Depakote, then, since the seizures are much more harmful to the unborn baby than the very small risk of Depakote, Depakote should be used. Situations where we prescribe Depakote in women of childbearing age are: Juvenile Myoclonic Epilepsy, Primary Generalized Epilepsy with both Absences (Petit Mals) and Generalized Tonic-Clonic Seizures (convulsions, grand mal seizures), and Generalized Tonic-Clonic Seizures not controlled on other medications usually those with myoclonus or massive jerking in between seizures. Drug-to-Drug Interactions: Usage of any medications containing Phenobarbital or barbiturates should be avoided while taking Depakote, as Depakote may cause the Phenobarbital to accumulate to high levels in the bloodstream. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. Phenobarbital and Clonazepam (Klonopin) can interact with Depakote and cause fatigue and tiredness. In some patients the combination of Depakote and Tegretol increases one of the breakdown products of Tegretol (the epoxide) which at higher levels can be toxic. It is important for your doctor to monitor the ammonia in the blood if you feel tired or sleepy Levels of Depakote that control seizures are 70-120. Occasionally higher levels up to 180 are successful without a major increase in side effects. As with most of the other medications the therapeutic level can be higher than the usual therapeutic range of a laboratory. It typically takes one week for Depakote serum levels to reach a steady state. Depakote Sprinkles are a very useful dosage form. They have a much smoother rise in the blood level and maintain a more stable blood level than the regular Depakote tablets. Many patients who cannot tolerate regular Depakote can easily manage the sprinkles. Furthermore the capsule containing the sprinkle can be opened and the sprinkles mixed with applesauce or other food to make it more palatable for children who can't take pills. IF THE DEPAKOTE LEVEL IS TOO LOW, no symptoms will be felt by the patient. However, break-through seizures may occur. IF THE DEPAKOTE LEVEL IS TOO HIGH, nausea, vomiting and dizziness are the most common symptoms. Depakote also increase the ammonia levels in the blood and it is important for your doctor to monitor this. If you experience unusual lethargy, feelings of drowsiness or a "drunkenness" feeling, contact your doctor and have your levels checked immediately. If your level is too high, the doctor will give you carnitine and/or Lactulose to lower your level. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician.
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Mysoline
	Generic Name: Primidone This is anexcellent medication for complex partial seizures and for some Myoclonic seizures. Mysoline is an active barbiturate and breaks down to pema and to phenobarbital. The pema is an active anti-convulsant and therefore Mysoline has additional effectiveness in controlling seizures beyond phenobarbital. Therefore it's important to get both Mysoline (Primidone) and phenobarbital levels for a person on Mysoline. Both must be requested when getting a blood level. Many patients tolerate Mysoline better than other barbiturates. In many patients there are no day-to-day changes in mental function whereas other patients become drowsy. Each person's reaction to Mysoline can be individual. In many patients Mysoline is an excellent AED, controlling the seizure without side effects. Mysoline comes in two tablet strengths - 250 mg and 50 mg. Both are score tablets so that Mysoline can be easily adjusted in 50 mg increments. Since the usual daily dose is 500 mg to 750 mg the dose can be very finely tuned with the 25 mg increments to the optimum dose with the best benefit/risk ratio (seizure control/side effect ratio). Side Effects: The most frequently occurring side effect is a sense of imbalance and vertigo (sensation of spinning). This tends to disappear with continued therapy. Occasionally, nausea and loss of appetite, emotional disturbance, sexual impotency or skin rash may occur. IF THE MYSOLINE LEVEL IS TOO LOW, no side effects will be felt, however, break-through seizures may occur. IF THE MYSOLINE AND PHENOBARB LEVELS ARE TOO HIGH, drowsiness, sleepiness, dizziness and unsteadiness of gait may occur. Nausea and vomiting may also occur. You should report these symptoms to your physician. If Mysoline is withdrawn, it should be done very slowly to prevent withdrawal seizures. Feelings of irritability and agitation may occur during the withdrawal period. Drug-to-Drug Interactions: Mysoline is metabolized to Phenobarb. This is why your doctor will check both the Mysoline and the Phenobarb level if you are on Mysoline. Caution should be applied if Depakote is added to Mysoline. Depakote can make the Phenobarb metabolite of Mysoline rise into the toxic range. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician.
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Klonopin
	Generic Name: Clonazepam Thismedication is given for certain seizure types including myoclonic seizures, intractable absence seizures and Lennox-Gastaut syndrome. Side Effects: Patients commonly experience drowsiness, lessened muscular coordination. In many cases these side effects diminish over time. Children frequently develop behavioral problems which only stop after the drug is tapered and discontinued. Due to these side effects Klonopin usually is used as a third line drug for intractable seizures. Drug-to-Drug Interactions: Usage of Klonopin should be avoided while taking Depakote, as Depakote may cause the Klonopin to accumulate to high levels in the bloodstream causing sedation and even stupor. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. IF THE KLONOPIN LEVEL IS TOO LOW, no symptoms will be felt by the patient. However, break-through seizures may occur. IF THE KLONOPIN LEVEL IS TOO HIGH, somnolence, confusion, and diminished reflexes. Klonopin blood levels are less useful than levels of other AEDs and it is customary to adjust Klonopin dosage based on clinical response without blood levels. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication or abruptly stop taking it without first consulting your physician.
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Zarontin
	Generic Name: Ethosuximide Thismedication is advantageous in the control of simple absence seizures (petit mal). Its use is primarily in this seizure type. Side Effects: May impair alertness and nausea. Less common side effects include dizziness, drowsiness, and irritability. Abnormalities in the blood have been reported as well as liver and renal problems. Therefore periodic blood counts, urinalysis and liver function tests should be performed. Drug-to-Drug Interactions: Periodic blood levels should be performed when Zarontin is used together with other anti-epileptic medications since it can effect the therapeutic levels of other anti-epileptic medications. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. IF THE ZARONTIN LEVEL IS TOO LOW, no symptoms will be felt by the patient. However, break-through seizures may occur. IF THE ZARONTIN LEVEL IS TOO HIGH, patient may feel similar but more severe side effects such as those listed above. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician.
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Felbatol
	Generic Name: Felbamate Felbatol isvery effective for many types of seizures both as add-on therapy with other medications or as a monotherapy. It is effective in severe complex partial seizures and in the difficult to treat Lennox-Gastaut Syndrome (see definitions). Unfortunately, after a year on the market a number of fatal cases of aplastic anemia and hepatitis linked to the use of the medication were reported and most physicians only prescribe it for patients where no other treatment is effective. Side Effects: The most common side effects of this medication when used alone are weight loss, insomnia, and headache. The most common side effects seen in association with other medications are nausea, dizziness, and somnolence. There are substantially higher rates of side effects when patients are receiving other antiepileptic medications and conversion to monotherapy often reduces side effects. The most serious potential side effects from Felbatol includes aplastic anemia and liver failure. Complete blood count (CBC), reticulocytes, and liver function blood tests should be performed before Felbatol therapy every two weeks thereafter for three months, every month up to one year and every three months thereafter. These tests also should be checked three months after discontinuation of Felbatol. IF THE FELBATOL LEVEL IS TOO LOW, no symptoms are felt, however, you may experience break-through seizures. IF THE FELBATOL LEVEL IS TOO HIGH, toxic symptoms may occur. These usually include persistent insomnia and headache. If these symptoms occur, you should report them to your doctor immediately. If you are experiencing symptoms that may indicate your level is too low or too high, your doctor will usually change your Felbatol dose. Blood levels usually are less useful with Felbatol than with the standard AEDs. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician. Drug-to-Drug interactions: Felbatol has significant interactions with Dilantin, Depakote and Valproate. Felbatol effects the concentrations of these medications in the blood and your physician will need to make adjustments in these medications.
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Lamictal
	Generic Name: Lamotrigine Lamictal iseffective in adults with complex partial seizures and secondarily generalized seizures. It is most effective when used as an add on therapy with other anti-epileptic medications. Side Effects: The most common side effects of this medication are dizziness, drowsiness, blurred or double vision, lack of coordination and headache. A higher incidence of skin rash has occurred with this drug, especially if the dosage is rapidly increased when up to 10% of patients develop a rash. If a rash occurs, we usually stop the medication for two weeks and re- institute it at a lower dose and increase the dose more slowly. It is especially important to start Lamictal at a very low dose with Depakote (valproic acid) and slowly increase the dose. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. Therapeutic levels have not been established for Lamictal, however, if you experience an increase in seizures or continue to experience side effects following the initial 2-3 three weeks after starting the medication, contact you physician for an evaluation. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician. Drug-to-Drug interactions: Lamictal does not appear to affect other antiepileptic drugs.
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Phenobarbital
	Phenobarbital is an anti-epileptic medication that is used only after other anti-epileptic medications have been tried. Side Effects: Although phenobarbital is associated with significant behavioral and subtle cognitive effects, it may cause less toxicity (hematopoietic, hepatic) than the other drugs. Drowsiness is the most common side effect although patients usually develop a tolerance to the drug. It can markedly influence behavior, can provoke irritability in children, particularly hyperactivity, and exacerbate exiting behavioral problems in adults. This drug has been known to be habit forming, however, this rarely occurs when used as an anti-epileptic medication. Abrupt termination of therapy usually causes withdrawal seizures and it is very important not to change your dose or discontinue use of the drug without the care of your physician. Phenobarbital can be taken once a day, like Dilantin. This convenience can improve compliance (taking the drug regularly and correctly) and is an advantage. It used to be customary practice that when Dilantin failed to control seizures, phenobarbital was added. This is no longer considered state of the art therapy. Addition of Neurontin to Dilantin or switching to monotherapy Tegretol would be considered the next step if Dilantin in highest tolerated doses does not work. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. IF THE PHENOBARBITAL LEVEL IS TOO LOW, no symptoms are felt, however, you may experience break-through seizures. IF THE PHENOBARBITAL LEVEL IS TOO HIGH, toxic symptoms may occur. These usually include excessive drowsiness and lethargy. If you are experiencing symptoms that may indicate your level is too low or too high, your doctor will have you obtain a lab test to check your phenobarbitol level. If the level is not therapeutic, he will likely increase or decrease your medication. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician. Drug-to-Drug interactions: Phenobarbital and Dilantin used together may result in changes of each drug in the blood stream. When used in conjunction with Dilantin, blood levels should be checked regularly. Phenobarbital increases liver metabolism or breakdown and elimination of AEDs and other drugs. It can decrease the clinical effectiveness of oral anticoagulants, oral contraceptives, anti-infectives (chloramphenicol, doxycycline, griseofulvin), lipophilic beta-blockers (eg, Propranolol, metoprolol), corticosteroids, cyclosporine, tricyclic antidepressants (eg, desipramine, nortriptyline, haloperidol, phenothiazines, Quinidine, theophylline, digitoxin, doxorubicin, and Verapamil.
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Neurontin
	Generic name: Gabapentin Neurontin isgenerally used in adults in conjunction with other anti-epileptic medications for partial and secondarily generalized seizures. The most celebrated feature of this drug is its lack of interactions with other drugs which, with its unique mechanism of action makes it the optimum add on drug for rational polytherapy. Rational polytherapy: Monotherapy is preferred for treating seizure disorders due to simplicity, lack of drug-drug interactions and fewer side effects. Recently, however, rational polytherapy has become increasingly used for several reasons. First, about 30% of all patients continue to have uncontrolled seizures despite a trail of all AEDs. Second, the newly available AEDs have different mechanisms of action than the standard AEDs. Therefore, their efficacy or effectiveness for control of seizures can add together with the efficacy of the standard AEDs to improve control of seizures. Third, the availability of new AEDs with little side effects and little drug-drug interactions, like Neurontin, can avoid the usual problem with polytherapy. Side effects: The most common side effects from Gabapentin are mild fatigue and dizziness. Other side effects have been nystagmus, hypotension, diarrhea, muscle weakness, dry mouth, sleep disturbances, slurred speech, decreased alertness, tremor, rash, and nausea.These side effects can be reduced or eliminated by starting and increasing the dose slowly. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. IF THE NEURONTIN LEVEL IS TOO LOW, no symptoms are felt, however, you may experience break-through seizures. IF THE NEURONTIN LEVEL IS TOO HIGH OR THE DRUG DOSAGE IS INCREASED TOO FAST, toxic symptoms may occur. These usually include dizziness, fatigue and a "drunkenness" feeling. They usually can be avoided by more gradual changing of dose. Neurontin usually can be pushed to a higher dose with fewer side effects than most other AEDs. If you are experiencing symptoms that may indicate your level is too low or too high, your doctor will adjust your dose. Although Neurontin levels can be checked, they are less useful than other AED levels and clinical response usually without levels is the customary indicator to follow. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician. Drug-to-Drug interactions: The major feature of Gabapentin is its lack of interaction with other drugs.
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Tranxene
	Generic name: Clorazepate dipotassium This medicationis used as an add on therapy in for partial seizures. This is an add on medication. It does have have benefits but its effects usually only last for about six months. We usually use the other AEDs and use Tranxene in special circumstances. Side effects: The most frequently reported side effect is drowsiness. Other less common reactions are dizziness, gastrointestinal complaints, nervousness, blurred vision, dry mouth, headache and mental confusion. Drug-to-Drug Interactions: Careful consideration should be given when combined with other drugs acting on the central nervous system. With all anti-epileptic medications, it is important to maintain an adequate amount of the drug in your body. IF THE TRANXENE LEVEL IS TOO LOW, no symptoms will be felt by the patient. However, break-through seizures may occur. IF THE TRANXENE LEVEL IS TOO HIGH, patient may feel similar more severe symptoms similar to the side effects. Since it is necessary to have a sufficient amount of your anti-epileptic medication in your blood in order to control seizures, it is important that you follow your doctor's prescription. Do not adjust your medication without first consulting your physician.
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ACTH
	Generic name: Adrenocorticotropic Hormone ACTH is used in various types of childhood epilepsy that do not respond to the routine seizure medications. It is a primary drug in the treatment of infantile spasms. Parents are trained in the administration of the gel which is given intramuscularly once or twice daily . Side effects: Possible side effects of ACTH are irritability, increased appetite and weight gain, high blood pressure, low potassium in the blood, and high blood sugar. These side effects will go away once the ACTH is stopped. Other side effects are rare but more serious. These include infections, changes in mental status because of high blood pressure, renal failure and bleeding from the gastrointestinal system. The impact of these side effects can be lessened if parents are taught the early signs to look for in the child. Blood pressure should be checked often.
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Ativan
	Generic name: Lorazepam Ativan is an anti-seizure medication which is used for the control of status epilepticus. Side effects: The most common side effect to Ativan includes drowsiness, weakness and confusion, depending on the dosage administered. There is a precaution to those individuals who are sickly, elderly or suffer from liver and renal disorders. In these cases low dosages are frequently monitored. There is a limited possibility of psychological dependence on Ativan. Withdrawal symptoms can occur if the drug is stopped abruptly. It may also intensify depression and feelings of suicide. Ativan can not be combined with alcohol as it will increase sedation on the nervous system.
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Carbatrol
	Generic name: Carbamazepine extended release capsules Carbatrol contains carbamazepine, which is a well known and widely used medication for controlling seizures. It usually is taken twice a day and can either be sprinkled on food or taken with or without food. Carbatrol is an anticonvulsant medication used to control partial seizures with complex symptomatology (psychomotor, temporal lobe) generalized tonic-clonic seizures (grand mal) and mixed seizure patterns which include the above or other partial or generalized seizures. Absence seizures (petit mal) do not appear to be controlled by carbamazepine. Side effects: The most common side effects tend to occur at the beginning of therapy and they may include dizziness, drowsiness, unsteadiness, nausea and vomiting. Some people who take carbamazepine develop serious but rare blood disorders. To check for these, your physician may order blood tests from time to time. Carbatrol should be used with caution in patients with a mixed seizure disorder that includes atypical absence seizures. Patients should report early toxic signs and symptoms of a potential hematological problem, such as fever, sore throat, rash, ulcers in the mouth, easy bruising, petechial or purpuric hemorrhage to their physician. Carbatrol can cause fetal harm when administered to a pregnant woman.
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Carnitine
	Generic name: N/A Carnitine is a protein found in all tissues and is essential to energy production. Plasma Carnitine levels are decreased in many people with epilepsy. It may be a result of nutritional factors, metabolic disorders, or the effects of specific drug effects and diseases. Many times it is recommended for patients taking Valproate because of hyperammonemia is a common occurrence with this drug. Side effects: Transient nausea, vomiting, abdominal cramps, gastrointestinal symptoms and diarrhea may occur in some patients.
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Diamox
	Generic name: Acetazolamide Diamox is used to control absence seizures, generalized tonic clonic seizures and as an add on drug in partial seizures. The development of tolerance to its anticonvulsant effect is why it is not useful as a long term drug. The most dangerous adverse effect is aplastic anemia. Side effects: Short term use may cause side effects such as loss of appetite, sensitivity to the sun, fever, rash, thirst, headache, drowsiness and urinary difficulties. Tolerance to the medication may develop over the long term which may necessitate a need to increase the dosage. Monitoring the liver functions for possible negative reactions is recommended. Drug-to-Drug Interactions: Diamox can interact with salicylates (Aspirin) to produce serious metabolic acidosis.
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Diastat
	Generic name: Diazepam rectal gel Diastat is a gel formulation of diazepam intended for rectal administration in the management of selected, refractory, patients with epilepsy on stable regimens of AEDs, who require intermittent use of diazepam to control bouts of increased seizure activity. Diastat should only be administered by caregivers who in the opinion of the prescribing physician are able to distinguish the distinct cluster of seizures (and/or the events presumed to herald their onset) from the patient's ordinary seizure activity. Side effects: Because Diastat produces central nervous system depression, patients receiving this drug, who are otherwise capable and qualified to do so, should be cautioned against engaging in hazardous occupations requiring mental alertness, such as operating machinery, driving a motor vehicle or riding a bicycle. Prolonged CENTRAL NERVOUS SYSTEM depression has been observed in neonates treated with Diazepam. Therefore, Diastat is not recommended for use in children under six months of age. No clinical studies have been conducted with Diastat in pregnant women. Data from several sources raise concerns about the use of diazepam during pregnancy. Diastat is not recommended for chronic, daily use as an anticonvulsant because of the potential for development of tolerance to diazepam. If Diastat is to be combined with other psychotropic agents or other CENTRAL NERVOUS SYSTEM depressants, careful consideration should be given to the pharmacology of the agents to be employed - particularly with known compounds which may potentiate the action of diazepam, such as phenothiazines, narcotics, barbiturates, MAO inhibitors and other antidepressants. Valprorate may potentiate the CENTRAL NERVOUS SYSTEM-depressant effects of Diasepam. There have been no clinical studies or reports in literature to evaluate the interaction of rectally administered diazepam with other drugs. As with all drugs, the potential for interaction by a variety of mechanisms is a possibility.
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Keppra
	Generic name: Levetiracetam In December of 1999, the U.S. Food and Drug Administration (FDA) approved Keppra (Levetiracetam) as an anti-epileptic medication indicated as an adjunctive or added therapy to other anti-epileptic medications for the treatment of partial onset seizures in adults with epilepsy. Side effects: In clinical studies, Keppra was generally well tolerated. In controlled studies, when Keppra was given with other anti-epileptic medications, the most frequently reported adverse effects were somnolence, asthenia (lack or loss of strength), infection and dizziness. Adverse events were usually mild to moderate in intensity. Patients who have moderate or severe renal impairment should be followed closely since Keppra is excreted by the kidneys.
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Mogadon
	Generic name: Nitrazepam Mogadon is used to control myoclonic seizures and may be used in the treatment of West's syndrome (infantile spasms) and other seizures that occur in early childhood. It also induces sleep. Side effects: Common reactions to Mogadon include fatigue, dizziness, drowsiness, confusion and lack of coordination. Withdrawal symptoms including headaches may be felt if Mogadon is withdrawn abruptly. Patients who suffer from depression should be watched closely when on Mogadon. Pregnant women and breast-feeding mothers should avoid taking Mogadon. Consumption of alcohol must be avoided while taking Mogadon.
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Paraldehyde
	Generic name: N/A Paraldehyde is administered in the hospital through rectal infusion.
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Tegretol XR
	Generic name: N/A In 1996, Tegretol XR became available as a new extended release formulation allowing many patients to switch from three or four daily doses to a more convenient twice-daily regimen. Tegretol XR is indicated as a first-line monotherapy for the treatment of partial, secondarily generalized and generalized tonic-clonic seizures. Side effects: The most common side effect, particularly during the initiation phase of therapy, are dizziness, drowsiness, unsteadiness, nausea and vomiting. As with all anticonvulsant therapy, periodic hematological, and blood chemistry evaluations are recommended since low sodium levels and abnormal blood counts can occur. If you are experiencing symptoms that may indicate your level is too high or too low, your physician will require a lab test to check your level. If the level is not therapeutic, he will likely increase or decrease your medication. See Tegretol for drug-to-drug interactions.
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Gabitril
	Generic name: Tiagabine Hydrochloride Gabitril is used as an add-on medication for adults and adolescent patients over 12 years of age to control simple partial and complex partial seizures. Gabitril should be taken with food and should not be stopped immediately unless advised by a physician. Side effects: Cramps, nausea, vomiting, weight loss, diarrhea, increased appetite, mouth ulcers, dizziness, drowsiness, general weakness, nervousness, tremors, difficulty concentrating, depression, hostility, sore throat and difficulty swallowing, cough and skin rashes may occur in some patients. Patients with impaired liver function or liver disease may need to take a lower dosage. Safety in pregnant women and the effects on the nursing infant have not been established. Drug-to-Drug Interactions: Gabitril may cause a slight decrease in Valproate levels. There may also be an additive effect with Gabitril and other central nervous system depressants. Valproate may significantly increase the Gabitril level.
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Topamax
	Generic name: Topiramate In July of 1999, the U.S. Food and Drug Administration (FDA) approved a new use of the anti-epileptic drug, Topamax (topiramte) as an add-on treatment for pediatric patients (ages two to 16) and adults who experience partial onset seizures. Topamax is also an effective adjunctive treatment of primary generalized tonic-clonic seizures. Side effects: Clinical trials indicate that Topamax is generally well-tolerated by patients and has few clinically significant interactions with traditional anti-epileptic medications. The most common side effects associated with Topamax in pediatric patients included excessive drowsiness, loss of appetite, fatigue, nervousness, difficulty with concentration/attention, weight decrease, aggressive reaction and difficulty with memory. In adults the most common types of side effects were somnolence, dizziness, coordination problems, speech disorders, psychomotor slowing, abnormal vision, difficulty with memory, sensory distortion and double vision. Most side effects were mild to moderate in severity and usually disappeared over time. There was a 1.5 percent incidence of kidney stones, nearly 80% of patients experiencing stones continued their Topamax therapy.
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Trileptal
	Generic name: Oxcarbazepine The new drug Trileptal has been approved by the FDA as a therapy for the treatment of partial seizures in adults and children. Trileptal demonstrates fewer drug to drug interactions than other first-line monotherapy AEDs. Side effects: The most common side effects include headache, somnolence, dizziness, viral infection and nausea. A less common side effect is low serum sodium levels.
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Valium
	Generic name: Diazepam Diazepam is used to help control status epilepticus, severe recurrent convulsive seizures. Side effects: Some patients may experience drowsiness, nausea, blurred vision, headaches, slurred speech, confusion, impaired memory, retention of urine, constipation and skin rash. Do not take Valium with alcohol. Pregnant women should talk with their doctor before taking Valium. New mothers should avoid breast feeding while taking Valium.
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Zonegran
	Generic name: Zonisamide Zonegran is an anti-seizure medication used to treat partial seizures in adults. It is taken with other seizure medicines to help control seizures. Zonegran offers rapid absorption. Peak plasma concentrations occur two to six hours following 200 mg to 49\00 mg dose. Presence of food delays time to maximum concentration but bioavailability is unaffected. The precise mechanism by which Zonegran exerts its anti-seizure effect is unknown. Side effects: Adverse side effects are generally mild to moderate. Many of the adverse side effects were dose related. Since Zonegran is a sulfonamide, hypersensitivity or other serious reactions may occur. Consideration should be given to discontinuing Zonegran in patients who develop an otherwise unexplained rash. Also, some patients have experienced somnolence, dizziness, anorexia, headache, nausea and agitation/irritability. Increases in creatinine and blood urea nitrogen of 8% over baseline have occurred. Zonegran should not be used in patients with renal failure. Potentially serious reactions to Sulfonamides have occurred. Drug-to-Drug Interactions: There are few drug interactions. There is no effect on levels of phenytoin, carbamazepine or valproate. Anti-epileptic medications that inhibit or induce cytochrome P450 may increase/decrease the half-life of Zonegran. It does not induce liver enzymes.
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