Worsening of Epileptic Seizures and Epilepsies due to Antiepileptic Drugs – is it Possible?

Czech version

Authors: MUDr. Hana Ošlejšková
Authors‘ workplace: Klinika dětské neurologie LF MU a FN Brno
Published in: Cesk Slov Neurol N 2007; 70/103(2): 137-142
Category: Review Article

Overview

Antiepileptic drugs may paradoxically aggravate epileptic seizures and epilepsies. Predictable worsening due to an antiepileptic drug arises in the so-called „selective syndrome or seizure – specific aggravation“ or inverse pharmacodynamic effects. Absences and myoclonic seizures are the most risky. In idiopathic generalized and focal epilepsies, carbamazepine, vigabatrin, tiagabine, gabapentin and phenytoin aggravate absences and myoclonias. Juvenile myoclonic epilepsy is worsened with carbamezepine, phenytoin and, quite exceptionally, with lamotrigine. Benign rolandic epilepsy may change into the so-called “atypical form” due to carbamazepine with the increasing number of absences, by provoking negative myoclonus and with the evolution of EEG epileptiform abnormity into electrical status epilepticus in sleep. From symptomatic generalized epilepsies in Lennox-Gastaut syndrome, carbamazepine worsens atypical absences but it can improve tonic seizures, on the other hand, benzodiazepines and phenobarbital provoke tonic seizures (even in West´s syndrome). Lamotrigine deteriorates the course of severe Dravet myoclonic epilepsy.

To solve the worsening of seizures after applying an antiepileptic drug, its doses should be either reduced or discontinued and substituted with a new medicament. The best prevention is the correct diagnosis of epilepsy and precise classification of epileptic seizures and epilepsies.

Key words:
Therapy for epilepsy, antiepileptics, epileptic seizure, epileptic syndrome, worsening of seizures, undesirable effects, inverse pharmacodynamic effect of antiepileptics, tolerance

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