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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I am looking for a medicine to treat partial siezures

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2429 Questions

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Posted on Mon, 25 Feb 2019 in Epilepsy
Question: I am looking for a medicine to treat partial siezures that does not have such scarey or serious side effects as aggression, suicidal thoughts, paranoia, mood changes etc
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Answered by Dr. Dariush Saghafi 8 hours later
Brief Answer:
Conventional AED's ALL possess CONVENTIONAL side effects

Detailed Answer:
Good evening. Your question is a very good one and one that is constantly echoe'ed by patients and doctors alike. What can we prescribe from the standard of care literature for PARTIAL SEIZURES (any type of seizure as a matter of fact) that do not possess all of the potential SIDE EFFECTS you've mentioned.

The answer unfortunately is that there are no antiepileptics (AED's) which are considered efficacious and entirely WITHOUT the side effects you've mentioned. Every single drug that is available commercially by prescription in the U.S. will contain FDA mandated reporting of each and every SIDE EFFECT or SYMPTOM of a LATER designated SIDE EFFECT. And every AED on the market that is considered a serious candidate to control a person's PARTIAL SEIZURES carries the same warnings for psychiatric secondary effects such as but not restricted to aggression, increased irritability, suicidal ideation, paranoia, mood changes, insomnia or at times HYPERSOMNIA, and even a whole plethora of less than desirable side effects.

Let me repeat....there are NO medications that are considered to be FIRST LINE choices against partial seizures which which DO NOT CONTAIN the symptoms you've listed above. The reason these medications all work to stop, slow down, or at least hold stable SEIZURES is because they stabilize neuronal membrane action potentials. However, these medications are not very specific as to WHERE they can have their therapeutic effects.

Therefore, there are truly NO STANDARD medications available in the U.S. that exist to treat partial seizures (successfully) which do not either cause or must be labeled as potentially causing aggression, suicidal ideation, paranoia, and mood changes. Keppra and Vimpat are very safe drugs and very effective for the treatment of partial seizures. I always titrate these drugs slowly in patients who are particularly concerned about side effects and so any potential problems will show themselves early and be very easy to spot and easy to reverse.

Having said that, sometimes side effects can be fulminant and unexpected even at low doses so there is never a guarantee. The way we justify these very small risks when looking at the Phase III trial or Safety study data is to list out BENEFITS vs. RISKS of the medication. If you have partial seizures and you are actively having seizures then, you must go on some form of AED control and be known to be compliant and under full control before you can once again drive a car or work in an environment where power tools or other equipment are being used to can cause damage to either yourself or others.

I could list you a number of other alternatives to these drugs but in fact, just about every other drug that could be used can potentially cause not only the psychiatric symptoms but other physical NON-PSYCH symptoms that are more common and can be disabling as well. In other words, EFFECTIVE and PRESCRIPTIVE medications which are recognized as stopping or at least adequately controlling partial seizures are ALL without fail in possession of possible psychiatric symptoms that you've mentioned. However, you should know that the incidence of any of these side effects coming true and present are likely in the 5% or less category. If seizure control is of utmost importance to you then, I believe you must accept a prescription from your doctor and simply get on a REGULAR plan of vigilance as soon as possible.

Between Keppra dn Vimpat.....I've find KEPPRA to be the superior of the 2 and least likely to cause side effects. Vimpat probably does also have a side effect profile which is more likely to manifest compared to the KEPPRA.

However, it is also true that conventional success rates using prescription AED medications is on average felt to be only in the 65-75% range with the balance of people either not having success with standard medications or suffering from their side effects. You may wish to discuss ALTERNATIVE APPROACHES to treating epilepsy with our treating doctor and see if they would be willing to guide and advise you on some of these approaches which do have a scientific literature that backs their use up, however, you should understand that such OTHER agents or approaches have on average less than a 20% chance of being effective in gaining any type of control over seizures and for FULL CONTROL of symptoms whereby the patient can lead a perfectly normal and SEIZURE FREE lifestyle in on the order of only 10-15% of patients who use them. That means that between 85-90% of patients tried on alternative medication regimens will fail which is a much higher expected percentage than the 20-25% that may fail control with a recognized prescription agent.

Specifically, here is a small list of medications that are NOT conentional AED drugs that are known to have some degree of success in treating epileptic partial seizures:

Steroids (ACTH [tetracosactide], prednisolone), Intravenous immunoglobulins (IVIg),  Vitamins (pyridoxine, pyridoxal phosphate, biotin, Vitamin D, folinic acid), melatonin (HIGH and ULTRA HIGH doses).

Here is another list of alternative medications which are thought to be reasonable NATURAL candidates in a variety of types of epilepsy but in some cases evidence is insufficient to absolutely recommend or deny their effective use:

BACOPA-       Insufficient Evidence
BLACK SEED      Insufficient Evidence      
CANNABIDIOL      LIKELY EFFECTIVE      
CAPRYLIC ACID      Insufficient Evidence
DIMETHYLGLYCINE      Insufficient Evidence      
FISH OIL       Insufficient Evidence      
FOLIC ACID      Insufficient Evidence      
GABA (GAMMA-AMINOBUTYRIC ACID)      Insufficient Evidence      
N-ACETYL CYSTEINE      Possibly Effective      
TRANSFER FACTOR      Insufficient Evidence      
ZINC      Insufficient Evidence      

If I've provided useful and helpful information to your question could you do me a huge favor by CLOSING THE QUERY and include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 49 minutes of professional time in research, review, and synthesis for the purpose of formulating a return response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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