Epilepsy - Surgery

Medications

Anti-epileptic drugs (AEDs) include many types of medications but all act as anticonvulsants. Many newer AEDs are better tolerated than the older, standard AEDs, although they can still have troublesome side effects. Newer AEDs often cause less sedation and require less monitoring than older drugs. Although newer AEDs are generally FDA-approved for use as add-ons to standard drugs that have failed to control seizures, they are often prescribed as single drugs. Specific choices usually depend on the patient’s particular condition and the specific side effects of the AED.

All antiepileptic drugs can increase the risks of suicidal thoughts and behavior (suicidality). Research has shown that the highest risk of suicide can occur as soon as 1 week after beginning drug treatment and can continue for at least 24 weeks. Patients who take these drugs should be monitored for signs of depression, changes in behavior, or suicidality.

Valproate and Divalproex Sodium

Valproate (Depakene, valproic acid, generic) and its delayed release form, divalproex sodium (Depakote, generic), are anticonvulsants. Valproate is the most widely prescribed anti-epileptic drug worldwide. It is the first choice for patients with generalized seizures and is used to prevent nearly all other major seizures as well.

General Side Effects. Both of these drugs have a number of side effects that vary depending on dosage and duration. Most side effects occur early in therapy and then subside. General side effects include:

Stomach and intestinal problems, which are experienced by nearly half of patients after starting the drugs and may persist for several years of use.

Increased appetite with significant weight gain often becomes a problem and can be a major reason for noncompliance, particularly in young people.

Hand tremors, irritability, and hyperactivity in children are fairly common.

Temporary hair thinning and hair loss may occur.

Young girls may develop secondary male characteristics, and premenopausal women are at increased risk for menstrual irregularities and polycystic ovaries. The effects are reversible.

Valproate poses a higher risk for serious birth defects than many other AEDs and should be avoided, if possible, during the first trimester. [See "Treatment During Pregnancy" in Treatment section.]

In rare cases, pancreatitis, a serious and even life-threatening inflammation in the pancreas, may occur.

Valproate and divalproex sodium may rarely cause a potentially fatal, toxic effect on the liver, most likely to affect children under 2 years of age who have birth defects and are taking more than one antiseizure drug.

Kidney problems may develop, although they are generally not significant.