New Developments in Anti-Seizure Medications

Newer FDA-approved medication options for epilepsy

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Neurology is a rapidly changing field, with new developments occurring all the time. Within the field of epilepsy, five new anti-epileptic medications were approved by the Food and Drug Administration (FDA) in the five years between 2012 and 2017.

What These Medications Treat

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.

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

Trokendi XR (Topiramate)

Though topiramate (Topamax) was approved by the FDA in 1997 for the treatment of partial onset seizures, this is the extended release version, approved by the FDA in 2013. Trokendi XR can be used alone for patients age 10 or older who experience partial or tonic-clonic seizures and as a secondary treatment for patients age 6 or older who have partial or tonic-clonic seizures or Lennox-Gastaut syndrome.

Side effects can include confusion, mood problems, dizziness, fatigue, prickling or burning sensation in the skin, memory problems, difficulty concentrating, fever, infection, anorexia, weight loss, sleepiness, nervousness, cognitive problems, and slowed down thoughts and movements.

Trokendi XR is a capsule taken just once a day.

Briviact (Brivaracetam)

Approved in 2016, brivaracetam is specifically intended as a secondary treatment to treat partial onset seizures found in epilepsy in patients age 16 or older. It works by attaching to a protein called synaptic vesicle 2A, which helps stop seizures.

Side effects may include nausea or vomiting, fatigue, dizziness, and sleepiness. Briviact can be administered as a pill, an injection, or an oral solution, all taken twice a day.

Qudexy XR (Topiramate)

Like Trokendi XR, Qudexy XR is another extended release version of topiramate that was approved in 2014. Qudexy XR is also intended for monotherapy for patients age 10 or older who have partial or tonic-clonic seizures, but it can be used as a secondary treatment for patients age 2 and older who have partial or tonic-clonic seizures or Lennox-Gastaut syndrome as well. Trokendi XR is limited to patients age 6 and older.

Side effects of Qudexy XR can include confusion, fever, dizziness, sleepiness, memory problems, difficulty concentrating, anorexia, infection, mood problems, nervousness, weight loss, cognitive issues, burning or prickling sensation in the skin, and slowed down thoughts and movements. It's taken as a capsule once a day.

Aptiom (Eslicarbazepine Acetate)

Aptiom, approved in 2013, is a voltage-gated sodium channel blocker used as a secondary treatment for patients with partial onset seizures. How it works is unclear and it's still unknown if it's safe to use in children under the age of 4.

Side effects can include headache, nausea, sleepiness, fatigue, vertigo, tremor, blurred vision, nausea, vomiting, double vision, dizziness, and uncoordinated movements. Aptiom is a tablet that's taken once a day. 

Fycompa (Perampanel)

Like other anti-epileptics before it, perampanel has a new mechanism of action, targeting the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) ionotropic 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.

Side effects can include dizziness, weight gain, fatigue, irritability, falls, balance problems, drowsiness, uncoordinated movements, and nausea. Fycompa is a tablet that is taken once a day.

New Drugs Equal New Hope

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

Sources:

Franco V, French JA, Perucca E. Challenges in the Clinical Development of New Antiepileptic Drugs. Pharmacological Research. January 2016;103:95-104.

Center Watch. FDA Approved Drugs for Neurology. 2017.