The goal of pharmacological treatment of epilepsy is to control seizures without adverse medication-related side effects. This goal is not always attained. While primary generalized epilepsies respond well to medication, 45% of patients with partial epilepsies continue to have seizures despite optimal medical management. These patients seek a balance between seizures and medication related side effects.
Erectile Dysfunction
The established antiepileptic drugs (AEDs) are phenobarbital, phenytoin, carbamazepine, ethosuximide and valproate. Comparative efficacy studies show that simple and complex partial seizures are most likely to be controlled without significant adverse side effects by carbamazepine and phenytoin while secondarily generalized tonic clonic seizures will respond equally well to carbamazepine, phenytoin or valproate. Phenobarbital is equally efficacious but is less well tolerated because of sedative side effects. Nonconvulsive generalized seizures (absence) are well controlled with ethosuximide but tonic-clonic seizures are not. Valproate will control all forms of generalized seizures, including absence, myoclonic and tonic-clonic. Other useful AEDs include the benzodiazepines clonazepam, diazepam and Iorazepam. Canadian pharmacy viagra
Because there is overlapping efficacy for individual AEDs, the particular agent is often chosen because the side effect profile is best suited for the individual patient. Although each medication has specific and distinctive side effects, many side effects are common to all the agents. When considering medication toxicity, it is useful to differentiate acute, dose related and idiosyncratic effects. Specific acute and dose-related side effects will be discussed for each agent separately.
Muscle relaxants
Dose-related side effects are common and frequently limit use of a particular AED in an individual patient. While these side effects are associated with higher serum levels, the specific level at which an individual patient will develop signs of toxicity varies. A dose related side effect common to all AEDs is cognitive impairment. This arises in a significant minority of patients and will be described as “slowing”, difficulty with concentration, sleepiness and poor memory. Neuropsychological testing reveals prolongation in the time to complete cognitive tasks. Although phenobarbital and other barbiturate medications have the most marked effects in this area, all AEDs are capable of affecting some patients. Behavioral changes such as irritability, poor concentration and depression can arise with any of the AEDs.