Nontraditional Antiseizure Medications to Consider When Traditional Options Have Failed: Medications for Refractory...

In the field of epilepsy, the advent of precision medicine and the repurposing of medications for new applications have fortuitously allowed more accurate diagnosing and individually targeted therapeutics. Despite these advances, there remain patients who do not respond sufficiently-or at all-to traditionally prescribed treatments. Clinicians often need to be creative, using clinical experience and rigorous research to intuit the next step when most, if not all, anti-seizure treatments have not produced sufficient results. Herein we describe 5 medications with emerging reports of efficacy for seizure control identified by coauthor clinical experience and prescribers in clinical practice for drug information purposes (e.g., ketamine, memantine, quinidine, riluzole, trazodone). Additionally, we summarize pertinent pharmacokinetics, adverse effects, and known and potential interactions with neurologically focused medications to further guide clinical application. Ketamine and memantine appear to be promising options to apply to patients presently, while quinidine, riluzole, and trazodone have data that could contribute to future applications in specific patient populations.