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Anticonvulsants Used For Focal Seizures
Anticonvulsants Used For Focal Seizures
Relevant separate articles include Epilepsy in Children and Young People, Epilepsy in Adults and Epilepsy in
Elderly People.
NB: carefully consider the risk:benefit ratio when using vigabatrin because of the risk of an irreversible effect on
visual fields.
Interactions [4]
Interactions between AEDs are complex and may enhance toxicity without a corresponding increase in
anti-epileptic effect.
These interactions are very variable and unpredictable.
The dose of each medication should be titrated slowly to the maximally tolerated dose or the
maximum level as recommended in the British National Formulary. The effect may be monitored by
patient-recorded seizure frequency.
Formulations of AEDs are not interchangeable and generic substitution should not be routinely made.
Routine switching between different manufacturers of AEDs should be avoided.
Regular blood test monitoring is not recommended as routine and should be done only if clinically
indicated. Indications for monitoring of AED blood levels are:
Detection of non-adherence to the prescribed medication.
Suspected toxicity.
Adjustment of phenytoin dose.
Management of pharmacokinetic interactions (eg, changes in bioavailability, changes in
elimination, and co-medication with interacting drugs).
Specific clinical conditions - eg, status epilepticus, organ failure and certain situations in
pregnancy.
1. Diagnosis and management of epilepsy in adults; Scottish Intercollegiate Guidelines Network - SIGN (2015)
2. Epilepsies: diagnosis and management; NICE Clinical Guideline (January 2012)
3. Schmidt D, Schachter SC; Drug treatment of epilepsy in adults. BMJ. 2014 Feb 28;348:g254. doi: 10.1136/bmj.g254.
4. British National Formulary; NICE Evidence Services (UK access only)
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