New Developments in Anti-Seizure Medications

Summary of New Seizure Medications

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Neurology is a rapidly changing field, with new developments occurring all the time. Within the field of epilepsy, eight new anti-epileptic medications were approved by either the Food and Drug Administration (FDA) or the European Medicines Agency in the five years between 2007 and 2012.

Most of these medications were approved for partial seizures, that is seizures that just start in one spot of the brain rather than all at once.

In addition, some of the new anti-seizure drugs are used in hard-to-treat children's epilepsies, like Lennox-Gastaut syndrome.

In addition, many of these medications are used off-label, meaning that doctors are prescribing them for things other than what the FDA has allowed the company to advertise.


The intended use of Stiripentol is in young patients with Dravet's syndrome, a rare and potentially serious form of epilepsy. The exact mechanism is unknown, but it's thought to work in a similar manner to barbiturates.

Stiripentol is metabolized by the liver. Other drugs that are also metabolized by the liver, such as phenytoin, may not be metabolized as quickly in someone who is also taking stiripentol -- meaning that concentrations of these drugs in the blood may be higher. On one hand, this may make the drug more effective, but on the other hand, levels may become so high that the drug becomes toxic.

Careful monitoring is recommended if other drugs are being taken.

Stiripentol is not currently available in the United States, so families often pay cash for it to be shipped from abroad.


Lacosamide is approved as an adjunctive treatment of partial-onset seizures in adults. It's increasingly found off-label for generalized seizures and status epilepticus.

 The drug works on a sodium channel in a unique fashion from previous drugs. It also has few interactions with other drugs.

The most common side effect with lacosamide is dizziness, which occurs in about a quarter of all who take the drug. Other potential side effects include balance disorders or double vision.


Rufinamide was approved in the United States in 2008 for the treatment of seizures in children with oxcarbazepine. It's also been approved for adults with Lennox-Gastaut syndrome


Vigabatrin has been available for years outside the United States. But up until 2009, it was not permitted in the United States due to the side effect of vision loss in up to a third of people who take the drug. It was approved in the United States in 2009, but only in severe situations, including children less than two years old with infantile spasms. It's also approved for the treatment of refractory complex partial seizures in children 10 years of age or older and adults.


Ezogabine is the first anti-epileptic medication to target a potassium channel.

It was approved in 2011 for the treatment of partial seizures, and can also be used to treat temporal lobe epilepsy. Unfortunately, it can have a side effect of urinary retention, as well as somnolence, dizziness, and confusion.


Clobazam is a benzodiazepine but is slightly different in structure. The drug has been available outside the US since 1970, but was only approved by the FDA in 2011 as an adjunctive treatment in children with Lennox-Gastaut syndrome, and resulted in up to a 70 percent reduction in seizures in these patients. The drug is further being used in other epilepsy syndromes, as well as many different kinds of seizures. As is often the case with anti-epileptic medications, those with kidney or liver damage are at increased risk of side effects from this medication.


Like other new anti-epileptics, perampanel has a new mechanism of action, targeting the α-amino-3-hydroxy-5-methyl-4-isozazole propionic acid (AMPA) inotropic glutamate receptor. Perampanel may interact with drugs like carbamazepine, oxcarbazepine or phenytoin and is used to treat adults and children 12 years of age or older with partial seizures, secondarily generalized seizures, or primary generalized tonic-clonic seizures

Bottom Line

At present, almost a third of patients with epilepsy have seizures that cannot be well-controlled with medication alone. By bringing forth new drugs with new strategies, our hope is to one day have a world that is seizure free.


Bialer M, White HS. Key factors in the discovery and development of new antiepileptic drugs. Nat Rev Drug Discov 2010;9:68-82.

Epilepsy Foundation. Treating Seizures and Epilepsy: Seizure and Epilepsy Medications

Faught RE. Efficacy and Adverse Effects of Newer AEDs in Approved Indications. In: American Epilepsy Society Annual Meeting; 2012; San Diego, California, 2012.

Johannessen Landmark C, Johannessen SI, Tomson T. Host factors affecting antiepileptic drug delivery-pharmacokinetic variability. Adv Drug Deliv Rev 2012;64:896-910.

Kossoff, E. (2014). Stiripentol for Dravet Syndrome: Is it worth it? Epilepsy Currents, 14(1):22-23.

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