Thursday, April 24, 2025

Blog # 176: FOUR FIRST LINE ANTIEPILEPSY DRUG SIDE EFFECTS COMPARED

 



A multi-center study in Neurology Today September 19, 2024; volume 24; issue 18; page 9 entailed results of clinical investigations in 37 tertiary epilepsy centers in the United States, Australia and Europe. The goal was to advise clinicians and patients as to the most effective antiepilepsy (AED) drugs with the BEST TOLERATED SIDE-EFFECTS. Keppra, Lamictal, Tegretol and Trileptal are all available as generics and are widely used. More drug side effects may result in patients stopping their meds despite their effectiveness.

From 2012 to 2020 two hundred twenty-five adults were studied. Of the participants 132 were taking levetiracetam (Keppra), 55 taking lamotrigine (Lamictal), 19 carbamazepine (Tegretol) and 19 oxcarbazepine (Trileptal). There were no significant differences in total Adverse Event Profiles (AEP) screening for depression and anxiety among the 4 drugs. Those on Keppra were three times more likely to have feelings of AGGRESSION but almost half of these experienced feelings of UNSTEADINESS compared with Lamictal. Discontinuation rates were 42.1% each for Tegretol and for Trileptal, 34.8% for Keppra and 16.4% for Lamictal. Keppra had the highest discontinuation rate because of adverse events alone——18%—and Lamictal users had the lowest discontinuation rate—5%. Across medications female patients were more likely to report FATIGUE, DOUBLE VISION OR HEADACHE.

An anecdotal conversation occurred among 10 epileptologist neurologists. The question arose, “If you developed epilepsy what drug would you want to be on?” The unanimous answer was Lamictal. This study should lead to greater awareness of possible mental health consequences of using Keppra. Doctors should not be afraid to change drugs if Keppra users begin to feel anxious or depressed. This study is not yet generalizable for consideration to other forms of epilepsy or to epilepsy drugs not included in this study.

Epilepsy patients are more likely to have ANXIETY AND DEPRESSION. It is not known whether mental health treatment improves epilepsy seizure control. Psychiatric conditions are common in epilepsy patients even before epilepsy is diagnosed. Keppra can make patients FEEL EDGY, ANGRY or MEAN rather than they describing themselves feeling aggressive or in a “Keppra rage.” Spouses and family may notice these personality traits before the patients themselves do. Neurologists must be aware of these mental affects of these AEDs.

AED side effects can affect drug compliance and seizure control. One need not hold to the initial AED choice since other drugs may be more effective in seizure control with fewer emotional side effects. Keppra was found to be the most frequently prescribed drug as emergency room non-neurologists often choose Keppra when someone is admitted with their first seizure. Prompt AED change when indicated can be very positive in the overall life of an epilepsy patient.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.