Anticonvulsant drugs for generalized tonic-clonic epilepsy

ABSTRACT

Introduction: Primary generalized tonic clonic seizures (pGTCS) are still linked to major concerns for the clinic and hazards for patients suffering from idiopathic generalized epilepsy (IGE), so a quick search of the most effective and appropriate therapy is needed to control them. The key criteria for proper treatment are syndromic diagnosis and distinction between newly diagnosed and refractory patients. Other criteria include age, gender and comorbidities.

Areas covered: Treatment for pGTCS has expanded in the last two years, with new antiepileptic drugs like perampanel joining valproic acid, lamotrigine, levetiracetam, topiramate, while further evidence-based data are required for zonisamide and lacosamide.

Expert opinion: Currently, valproic acid can be considered as a first choice in male or menopausal women, and in the absence of weight issue, both in adults and in children, and in the absence of side effects such as insomnia and headache. Today, valproic acid is not recommended in child-bearing age and in relation to possible cognitive problems, especially in children. Lamotrigine and levetiracetam can be a viable alternative as a first choice. Topiramate is also effective as a first choice, but concerns may arise from its potential cognitive and memory adverse side effects. Additionally, perampanel and lacosamide are promising treatments.

KEYWORDS:

• Antiepileptic drugs
• primary generalized epilepsy
• tonic-clonic seizures
• refractory seizures

Article highlights

• With respect to the treatment of primary generalized tonic-clonic seizures, newly diagnosed and refractory patients should be first distinguished.

• The treatment, currently, is primarily based on VPA, LTG, LEV, TPM and ZNS.

• In addition to LTG, TPM, LEV and ZNS, treatment options are so far extended to PER and LCM

• Controlled studies on GBP and pregabalin in pGTCS are still ongoing.

• Sodium channel blockers including CBZ, LTG and PHT may aggravate/precipitate pGTCS especially if associated with myoclonic and/or absence seizures.

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Declaration of interest

G Coppola has received speaker fees and funding for attending scientific congress from Eisai Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed

Additional information

Funding

This paper was not funded