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Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected

Marjorie Bunch1, Shilpa Klocke2, Nicole Woodrich3

  • 1Department of Neurology, Albany Medical College, Albany, NY, USA.

Epilepsy Currents
|January 23, 2026
PubMed

Insights

Antiseizure medication (ASM)-induced liver injury is a significant concern in epilepsy treatment, often presenting as idiosyncratic hypersensitivity reactions. Understanding risk factors and monitoring can help prevent severe liver damage.

Area of Science:

  • Pharmacology
  • Hepatology
  • Neurology

Background:

  • Drug-induced liver injury (DILI) is a critical issue in epilepsy management.
  • Antiseizure medications (ASMs) can cause various liver injury phenotypes, frequently idiosyncratic and hypersensitivity-related.
  • Identifying risk factors is crucial for selecting appropriate ASMs and monitoring patients.

Purpose of the Study:

  • To review the spectrum of ASM-induced liver injury.
  • To discuss risk factors, prevention strategies, and emerging biomarkers for liver injury in epilepsy patients on ASMs.

Main Methods:

  • Literature review of typical patterns of ASM-induced liver injury.
  • Examination of drug- and patient-related risk factors.
  • Discussion of preventive measures and novel biomarkers.

Main Results:

  • ASM-related liver injury ranges from mild enzyme elevations to severe, life-threatening conditions.
  • Idiosyncratic reactions are common, involving hypersensitivity.
  • Risk factor awareness aids in treatment selection and monitoring.

Conclusions:

  • Proactive identification of risk factors and vigilant monitoring are essential for managing ASM-induced liver injury.
  • Emerging biomarkers may offer future diagnostic and prognostic benefits.
  • Optimizing ASM selection and management can mitigate liver injury risks in epilepsy patients.
Keywords:
DRESSSJS/TENantiseizure medicationsdrug-induced liver injuryhepatotoxicityhypersensitivity reactionsliver tests

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