Anticonvulsant medications

The understanding of epilepsy has advanced substantially in the past decade, and new anticonvulsant drugs with novel mechanisms of action are continually being developed. Some of these newer (and older) medications have been discussed in this article. A wide variety of other drugs is occasionally used in the management of epilepsy. Although parenteral magnesium sulfate is used mainly for the prevention and control of seizures in severe preeclampsia or eclampsia, parenteral magnesium sulfate may also be useful in controlling epileptic seizures associated with low plasma magnesium concentrations. Although considered obsolete, bromides have been useful in the management of tonic-clonic or myoclonic seizures in some infants and preadolescent children when other drugs were unsuitable. Acetazolamide may be useful in the management of refractory partial, myoclonic, absence or primary generalized tonic-clonic seizures; however, tolerance develops to the effect of the drug. Corticotropin and corticosteroids are sometimes used in the management of myoclonic seizures in infants. Steroids may be used in seizures due to intracerebral malignancies and metastasis but are more effective in blunting the intracranial swelling associated with these diseases. Recognition of these new drugs may allow the paramedic or EMT to identify seizure patients in the field. Knowledge of the side effects of these medications may be used to guide patients into appropriate treatment pathways.