If your seizure control is notsatisfactory, and if you and your doctor are trying different antiepilepticdrugs (AED), be aware that some side-effects can be more common with certainAEDs and less with others. Your choice could be beneficial for you. This topicwas reviewed by Mary Beth Nierengarten in the November 21, 2024, issue ofNeurology Today page 9. Older adults with epilepsy are much more likely toexperience new cardiovascular events, including strokes, transient ischemicevents (TIA) and heart attacks if they take the enzyme-inducing antiepileptic drugs.1

Enzyme-inducing antiepilepticdrugs (EIAEDs) are a class of medications used to manage seizures. They havethe effect of increasing the activity of certain liver enzymes, primarily thecytochrome P450 (CYP450) family. How Enzyme Induction Works:

•    EIAEDs, theenzyme-inducing drugs, stimulate the production of CYP450 enzymes in the liver.

•    These enzymesare responsible for metabolizing (breaking down) many drugs and othersubstances in the body. Carbamazepine (Tegretol), Phenytoin (Dilantin),Phenobarbital (Luminal)and Primidone (Mysoline) are the classicalenzyme-inducing antiseizure drugs (ASDs). Non-enzyme-inducing ASDs includeLevetiracetam (Keppra), Lamotrigine (Lamictal), Lacosamide (Vimpat). The EIAEDswere used in a third of those with the increased risk and this Canadian study (reference1) highlights the risk of long-term use of these medications for epilepsy.Co-morbidities with other medical diseases, especially cardiovascular risks,should be considered when choosing among 25 commonly used AEDs.

Those patients studied ranged inage from 62 to 85. Most were white. males and females of comparable numbers.None in the study had had a previous reported stroke, transient ischemic attack(TIA) or heart attack but the study showed 24.6% of the enzyme-inducing ASMswere then associated with new-onset cardiovascular events. Consider thesefindings, if possible, with your doctor when choosing your first-line therapy,avoiding Tegretol, Dilantin, Phenobarbital, and Primidone. If you havecardiovascular symptoms and risks, consider an EIAED as Levetiracetam (Keppra),Lamotrigine (Lamictal) or Lacosamide (Vimpat). Other common AED adverseeffects, e.g. balance and cognition problems, should also be discussed withyour physician.

We need to take a comprehensiveapproach for long-term outcomes for patients with epilepsy as most patientswith epilepsy will be on these medications for decades or life-long.

1.    Li J, Shlobin NA, Thijs RD, et al.Antiseizure medications and cardiovascular events in older people withepilepsy. JAMA Neurol 2024; Epub 2024 Sept 30.

Lance Fogan, M.D., is Clinical Professor of Neurology at theDavid Geffen School of Medicine at UCLA. His hard-hitting emotional family medicaldrama, “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.

  and is now available in eBook, audiobook, soft and hard cover editions.