Emergent Complications of the Newer Anticonvulsants

Antiepileptic drug prescribing patterns in Iraq and Afghanistan war veterans with epilepsy

“…Patients with comorbid psychiatric conditions, headache, and neuropathic pain may also be treated with AEDs for which there are multiple indications for use (e.g., valproate for bipolar disorder and headache and topiramate for headache). Alternatively, some comorbid conditions may be negatively affected by certain AEDs, such as increased or reoccurring psychiatric symptoms after use of levetiracetam [4][5][6][7]. Finally, because of the potential for drug interactions and side effects in older patients, age should be considered when selecting AEDs (e.g., phenytoin and phenobarbital) [8].…”

Moderate toxic effects following acute zonisamide overdose

“…Seizures were not observed during the 7-day hospitalisation period, although exacerbation of seizure activity has been described in association with overdose of several AEDs, also with the newer drugs [21]. Presumably the patient had sufficient seizure protection by her medication with clobazam and lacosamide.…”

Complete heart block and death following lamotrigine overdose

“…2,6,7 Lamotrigine exerts its antiepileptic effect through inhibition of voltage-gated sodium channels. 1 While the primary target is neuronal tissue, lamotrigine has the potential to block cardiac sodium channels as well.…”

“…Consequently, wide complex rhythms have been described, though infrequently, following lamotrigine use in both therapeutic 4 and overdoses. 2,7 Common symptoms following overdose include drowsiness, vomiting, nausea, ataxia, vertigo, and tachycardia. 2 Other reported complications include seizures, 6 anticonvulsant hypersensitivity syndrome, 3 respiratory depression, 7 and choreiform dyskinesia.…”