A multi-center study in NeurologyToday September 19, 2024; volume 24; issue 18; page 9 entailed results ofclinical investigations in 37 tertiary epilepsy centers in the United States,Australia and Europe. The goal was to advise clinicians and patients as to themost effective antiepilepsy (AED) drugs with the BEST TOLERATED SIDE-EFFECTS.Keppra, Lamictal, Tegretol and Trileptal are all available as generics and are widelyused. More drug side effects may result in patients stopping their meds despitetheir effectiveness.

From 2012 to 2020 two hundredtwenty-five adults were studied. Of the participants 132 were takinglevetiracetam (Keppra), 55 taking lamotrigine (Lamictal), 19 carbamazepine(Tegretol) and 19 oxcarbazepine (Trileptal). There were no significantdifferences in total Adverse Event Profiles (AEP) screening for depression andanxiety among the 4 drugs. Those on Keppra were three times more likely to havefeelings of AGGRESSION but almost half of these experienced feelings ofUNSTEADINESS compared with Lamictal. Discontinuation rates were 42.1% each for Tegretoland for Trileptal, 34.8% for Keppra and 16.4% for Lamictal. Keppra had thehighest discontinuation rate because of adverse events alone——18%—and Lamictalusers had the lowest discontinuation rate—5%. Across medications femalepatients were more likely to report FATIGUE, DOUBLE VISION OR HEADACHE.

An anecdotal conversationoccurred among 10 epileptologist neurologists. The question arose, “If youdeveloped epilepsy what drug would you want to be on?” The unanimous answer wasLamictal. This study should lead to greater awareness of possible mental healthconsequences of using Keppra. Doctors should not be afraid to change drugs ifKeppra users begin to feel anxious or depressed. This study is not yetgeneralizable for consideration to other forms of epilepsy or to epilepsy drugsnot included in this study.

Epilepsy patients are more likelyto have ANXIETY AND DEPRESSION. It is not known whether mental health treatmentimproves epilepsy seizure control. Psychiatric conditions are common inepilepsy patients even before epilepsy is diagnosed. Keppra can make patientsFEEL EDGY, ANGRY or MEAN rather than they describing themselves feelingaggressive or in a “Keppra rage.” Spouses and family may notice thesepersonality traits before the patients themselves do. Neurologists must beaware of these mental affects of these AEDs.

AED side effects can affect drugcompliance and seizure control. One need not hold to the initial AED choicesince other drugs may be more effective in seizure control with fewer emotionalside effects. Keppra was found to be the most frequently prescribed drug asemergency room non-neurologists often choose Keppra when someone is admittedwith their first seizure. Prompt AED change when indicated can be very positivein the overall life of an epilepsy patient.

Lance Fogan, M.D. is Clinical Professor of Neurology at theDavid Geffen School of Medicine at UCLA. His hard-hitting emotional familymedical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his firstnovel. Aside from acclamation on internet bookstore sites, U.S. Report ofBooks, and the Hollywood Book Review, DINGS has been advertised in recent NewYork Times Book Reviews, the Los Angeles Times Calendar section and PublishersWeekly. DINGS teaches epilepsy and is now available in eBook, audiobook, softand hard cover editions.