ACTH® (generic: adrenocorticotropic hormone -- HP Acthar Gel)
Manufacturer: Rhone-Poulenc-Rorer

ACTH is a hormone often prescribed for the treatment of infantile spasms, although this use has not been submitted for U.S. Food and Drug Administration approval. How ACTH works to prevent seizures (its mechanism of action) is unknown. A number of side effects may be associated with the drug, including changes in appearance and irritability in infants, stomach ulcers, severe infection, heart failure and kidney and pancreatic calcifications.

Carbatrol® (generic: extended release carbamazepine -- car-ba-MAZE-i-peen)
Manufacturer: Shire US Inc.

Carbatrol (CAR-ba-trol) is used in the treatment of all types of partial seizures and in the treatment of generalized tonic clonic (grand mal) seizures. It is usually described as a first line treatment. Carbatrol is an extended release form of the drug, meaning that its active ingredient is released slowly in the body, avoiding the need for frequent dosing. Carbatrol is metabolized (processed) in the liver and interacts with several other epilepsy drugs and other medications, such as warfarin, theophyline, and doxycycline. It may reduce the effectiveness of other antiepileptic drugs which are also processed through the liver and with the effectiveness of birth control pills at standard doses. Commonly reported side effects include drowsiness, headache, dizziness, blurred vision, difficulty in thinking, diarrhea, double vision, nausea and vomiting. Rare effects include allergic skin rashes (in about 10 percent of patients). Some skin rashes may be severe. Bone marrow suppression and liver damage occur in rare cases. Storage in hot, humid surroundings may reduce its bioavailability by 50%. Bioavailability refers to the amount of the active ingredient in a drug that is available within the body to achieve its desired result. Safety in pregnancy has not been established. There is an increased risk of spina bifida in children of women taking this medication. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Depakene/Depakote®/Depakote ER® (generic: valproate/valproic acid/divalproex sodium
Manufacturer: Abbott Laboratories

Depakene/Depakote (DEP-a-keen) and Depakote (DEP-a-coat) are used as first-line or add-on therapy for generalized tonic clonic, generalized absence, partial seizures and myoclonic and drop attacks associated with the Lennox-Gastaut syndrome. They are thus effective over the whole range of epilepsy types, with particular efficacy for generalized epilepsy of no known cause. Depakote is made with a coating to prevent stomach upset. These drugs can be administered orally or rectally; they are available as syrup, sprinkles, tablets and capsules. Antiepileptic effects have been reported to increase over time in some patients. Depakote may take several weeks to become effective. The drugs interact with several of the major antiepileptic drugs, but not with the oral contraceptive pill. Nausea and vomiting are the most commonly reported side effects, also increased appetite and resulting weight gain, hair thinning or hair loss (usually temporary) and menstrual irregularities, including absence of the monthly period. Some studies suggest that these drugs can cause or contribute to the development in women of polycystic ovary syndrome (a collection of traits that also includes obesity, excessive growth of facial hair, and irregular or lack of menstrual periods). Other studies have found no such link. Future research should settle the matter. In the meantime, women concerned about this issue should discuss it with their physicians. Cases of liver failure (some fatal) have been reported in children under the age of 2 who were taking several antiepileptic drugs and had other disabilities. Other reported effects include cognitive effects, tremor, and elevated liver enzymes. Women who become pregnant while on these drugs have an increased risk of having a child with spina bifida or other birth defects; doctors may prescribe folic acid for women of childbearing age to reduce the risk. An injectable form of the drug (valproate sodium injection - Depacon) is now available. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Diamox® (generic: acetazolamide -- a-CEET-a-ZOL-a-myde)
Manufacturer: Lederle Laboratories

Diamox (DI-a-mox) was introduced as an antiepileptic drug in 1952. It has been used to treat a variety of seizure types, including generalized tonic clonic, absence, and as add-on therapy for partial seizures. It may also be prescribed to treat catamenial epilepsy (epilepsy related to the menstrual cycle). Tolerance may develop over 3 - 6 months. However, it may become effective again after withdrawal. Reported side effects include lethargy, loss of appetite, nausea, and, occasionally, kidney stones. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Diastat® (generic name: diazepam (di-AZ-e-pam) rectal gel)

Diastat (DI-a-STAT) is a formulation of diazepam specifically designed for rectal administration to control prolonged seizures and bouts of increased seizure activity (clusters). It is the first prescribed product of its type approved for use by non-medical caregivers. Caregivers will need to be instructed in how and when to use Diastat by the physician or other health professional. In clinical studies in both children and adults, Diastat decreased the nature and severity of the seizures as well as their frequency. Reported side effects were not considered to be significant, with somnolence (prolonged drowsiness, sleepiness) being the most common. The medication is available by prescription, in pre-measured applicators. Diastat should be used with caution in people with respiratory (breathing) difficulties, such as asthma or pneumonia, in the elderly, in women of child bearing potential, pregnancy and nursing mothers.

Dilantin® (generic name: phenytoin -- FENY-toy-n)
Manufacturer: Pfizer

Dilantin (Di-LAN-tin) was developed in 1938 as the first modern antiepileptic drug and has been used ever since as first line therapy for partial and generalized tonic clonic seizures. It is not effective against myoclonic, atonic (drop attacks) and absence seizures. Dilantin is generally given as capsules or chewable tablets, usually once or twice a day. A related product (Cerebyx - fosphenytoin) is available for intramuscular and intravenous use against status epilepticus (non-stop seizures), replacing the previous formulation. Dilantin is metabolized (processed) in the liver. It interacts with a number of other antiepileptic drugs and other drugs, including oral contraceptives, Coumadin, quinidine, vitamin D and folic acid. At high doses, a small additional dose or slightly lower dose produces disproportionately large changes in blood levels, with consequent seizures (when levels drop) or increased side effects (when level rise abruptly). At high levels, short term side effects such as difficulty in concentration, slow motor speed, unsteadiness, double vision, nausea and drowsiness may occur. Seizures may also increase. Longer term side effects include gum overgrowth (gingival hyperplasia), excessive hairiness (hirsutism), thickening of facial features, nystagmus, rash and folate deficiency. Rare reactions include serious rash, bone marrow suppression and effects on the lymph system and a lupus like syndrome. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Felbatol® (generic name: felbamate -- FEL-ba-mate)
Manufacturer: Wallace Laboratories

Felbatol (FEL-ba-tol) is used as add-on and single drug therapy in people whose seizures cannot be controlled with other medications. It is prescribed for adults over the age of 14 with partial seizures with or without secondary generalization. It is also used as add-on therapy for partial and generalized seizures (including drop attacks) associated with the Lennox-Gastaut syndrome in children. Felbatol is available in tablets or liquid. Initial response to the drug was positive in many patients; however, its association with aplastic anemia (between 1/3000 and 1/8000 cases) and liver failure (1/18,500 to 1/25,000) has limited its use. Felbatol is known to interact with Dilantin, Tegretol, TegretolXR, Carbatrol and Depakene/Depakote. Doses of these medications may have to be modified when Felbatol is used. It is generally regarded as best used as single drug therapy. Common side effects include trouble sleeping, headache, loss of appetite, weight loss, nausea and vomiting. Because of its potential for serious side effects, patients must be notified of its risks and are required to sign a consent form in advance. Routine monitoring of liver and bone marrow function is recommended, but will not necessarily warn of impending damage. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Gabitril® (generic name: tiagabine -- ti-AG-a-bin)
Manufacturer: Abbott Laboratories

Gabitril (GAB-i-tril) is used as add-on therapy for hard to control partial seizures in adults and is available in tablet form. It is metabolized (processed) through the liver and may interact with some antiepileptic drugs. It is rapidly absorbed and is usually prescribed to be taken with food to avoid sharp rises in blood level. It does not interact with carbamazepine or phenytoin; valproate levels may drop slightly. Dose-related side effects include sedation, fatigue or muscle weakness, nervousness, headache, fatigue, irritability, difficulty with concentration, tremor, and dizziness. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Keppra® (generic name: levetiracetam -- leva-ti-RAS-e-tam)
Manufacturer: UCB Pharma

Keppra (KEPP-ra) was approved by the Food and Drug Administration in 1999 as an add-on therapy for partial seizures in adults. It is available as tablets. Side effects include sleepiness, unsteadiness, infection, behavior disturbance and dizziness. Side effects are most likely during the first 4 weeks of treatment. Has not been reported to interact with other antiepileptic drugs, warfarin, or oral contraceptives. It reaches a steady state (that is, an effective treatment level in the blood) approximately two days after it is begun. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Klonopin® (generic name: clonazepam -- clo-NAZE-i-pam)
Manufacturer: Roche

Klonopin (KLON-o-pin) is one of a group of drugs called benzodiazepines (ben-zo-di-AZE-i-peens). It is quickly absorbed after being taken by mouth, reaching peak levels 1 to 2 hours after administration. Klonopin may be prescribed to treat a variety of seizure types, including absence seizures and the Lennox-Gastaut syndrome, but is mostly used as add-on treatment (that is, treatment in addition to another drug) for myoclonic and atonic seizures (drop attacks). However, it can make tonic-clonic (grand mal) seizures worse. Drug interactions are minimal; side effects include drowsiness, slurred speech, double vision, behavior changes, dizziness, and depression. Antiepileptic effects may decline over time. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Lamictal® (generic name: lamotrigine -- la-MO-tri-geen)
Manufacturer: GlaxoSmithKline

Lamictal (La-MIC-tal) is used as add-on therapy for partial seizures (with or without secondary generalization) in adults and for partial and generalized seizures associated with the Lennox-Gastaut syndrome in children. It is generally well tolerated; however, children appear to be at increased risk of severe rash. Approximately 1/1000 children and 1/2000 adults taking this medication will experience severe rash. This risk may increase when the drug is begun at high doses or when the dose is rapidly increased. From research reports it appears that this drug is effective across the complete range of seizure types, including partial seizures, generalized seizures of no known cause, and the Lennox-Gastaut syndrome. Good reports have been reported in patients with learning disabilities and multiple seizure types. Lamictal may be prescribed with vaproate (Depakene, Depakote), but the combination is linked to higher rates of rash and tremor. Lamictal is available in tablets and may be taken once or twice a day. It interacts with Dilantin, Tegretol, TegretolXR, Carbatrol, phenobarbital and Depakene but not with oral contraceptives. Side effects include double vision (diplopia), drowsiness, dizziness, ataxia, headache, nausea and vomiting and rash. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Mysoline® (generic name: primidone -- PRIM-i-doan)
Manufacturer: Elan Pharmaceutical

Mysoline (MY-so-leen) is used to treat partial seizures with or without secondary generalization and generalized tonic clonic (grand mal) seizures. It is available in liquid and tablets. Mysoline is metabolized (processed by the body) into phenobarbital and phenoethylmelanamide, both of which have antiepileptic effects. Like phenobarbital, Mysoline is not effective against absence or myoclonic seizures. Side effects include drowsiness, difficulty thinking, nausea, mental changes and unsteadiness. It is primarily used as an add-on drug. Again, like phenobarbital, if Mysoline is to be discontinued, it has to tapered slowly to

avoid rebound seizures or other negative effects. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Neurontin® (generic name: gabapentin -- gaba-PEN-tin)
Manufacturer: Pfizer

Neurontin (New-RON-tin) is approved in the U.S. as add-on therapy for partial seizures with or without secondary generalization (spread to become a grand mal seizure). It is available in capsules and tablets. This drug is not metabolized through the liver. The body gets rid of the unchanged drug through the kidneys. It does not interact with other antiepileptic drugs or other drugs (such as oral contraceptives) which are metabolized (processed) through the liver. Sedation, fatigue, dizziness and unsteadiness are the most common side effects. About 5 in a 100 patients experience weight gain. Flatulence (gas), diarrhea and myoclonic jerks may occur at high doses. No allergic reactions have been reported except for a few instances of rash. People with hard to control seizures may need doses of up to 4800 mg. daily to achieve control. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Phenobarbital®

This is the oldest antiepileptic drug in common use. A barbiturate, phenobarbital was first used as an antiepileptic drug in 1912. It is used for generalized tonic-clonic and complex or simple partial seizures in adults and children. It may also be used for myclonic seizures. Once considered to be a first line drug, it is now generally thought to be a second-line therapy because of its side effects, which include sedation, depression and agitation. Phenobarbital is prescribed as capsules, tablets, and in syrup. In some patients, phenobarbital may make absence seizures worse. Phenobarbital interacts with a number of other antiepileptic drugs. It may take two weeks or more for a therapeutic level to develop. Phenobarbital may produce drowsiness, difficulty thinking, loss of balance and, in children, hyperactivity. Some people have an allergic reaction that produces rash. Tolerance, and even addiction, may occur over time. If phenobarbital is to be discontinued, it should be done slowly to prevent rebound seizures or other problems. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Tegretol® (generic name: carbamazepine car-ba-MAZE-i-peen)
Manufacturer: Novartis Pharmaceuticals

Tegretol (TEG-re-tol) is used in the treatment of all types of partial seizures and in treatment of generalized tonic clonic (grand mal) seizures. It is usually described as a first line treatment. However, it is not effective and may even have negative effects for generalized absence and myoclonic seizures. Tegretol should be introduced gradually in low doses; slow increases in dose is likely to improve tolerance of certain side effects. This drug is metabolized in the liver and interacts with several other epilepsy drugs and other medications, such as warfarin, theophyline, and doxycycline. It may reduce the effectiveness of other antiepileptic drugs which are also processed through the liver, and with the effectiveness of birth control pills at standard doses. Commonly reported side effects include drowsiness, headache, dizziness, blurred vision, difficulty in thinking, diarrhea, double vision, nausea and vomiting. Rare effects include allergic skin rashes (in about 10 percent of patients). Some skin rashes may be severe. Bone marrow suppression and liver damage occur in rare cases. Storage in hot, humid surroundings may reduce its bioavailability by 50%. Bioavailability refers to the amount of the active ingredient in a drug that is available within the body to achieve its desired result. Safety in pregnancy has not been established. There is an increased risk of spina bifida in children of women taking this medication. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

TegretolXR® (generic name: extended release carbamazepine - car-ba-MAZE-i-peen)
Manufacturer: Novartis Pharmaceuticals

TegretolXR (TEG-re-tol XR) is used in the treatment of all types of partial seizures and in the treatment of generalized tonic clonic (grand mal) seizures. It is usually described as a first line treatment. However, it is not effective and may even have negative effects for generalized absence and myoclonic seizures. TegretolXR is an extended release form of the drug, meaning that its active ingredient is released slowly in the body, avoiding the need for frequent dosing and large initial doses. TegretolXR is metabolized in the liver and interacts with several other epilepsy drugs and other medications, such as warfarin, theophyline, and doxycycline. It may reduce the effectiveness of other antiepileptic drugs which are also processed through the liver and with the effectiveness of birth control pills at standard doses. Commonly reported side effects include drowsiness, headache, dizziness, blurred vision, difficulty in thinking, diarrhea, double vision, nausea and vomiting. Rare effects include allergic skin rashes, bone marrow suppression and liver damage. Storage in hot, humid surroundings may reduce bioavailability by 50%. Bioavailability refers to the amount of the active ingredient in a drug that is available within the body to achieve its desired result. Safety in pregnancy has not been established. There is an increased risk of spina bifida in children of women taking this medication. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Topamax® (generic name: topiramate -- to-PEER-a-mate)
Manufacturer: Ortho-McNeil Pharmaceutical

Topamax (TO-pa-max) is approved as an add-on medication for adults and children with partial seizures with or without secondary generalization and for seizures associated with the Lennox-Gastaut syndrome. It has been reported to be successful in myoclonic epilepsy and may have a role in the treatment of infantile spasms. Topamax is available in tablets and sprinkles. It may interact with Tegretol, TegretolXR, Carbatrol and Dilantin. It may also make the oral contraceptive pill less effective at standard doses; women taking this medication who also take birth control pills will require a higher dosage to prevent pregnancy. Reported side effects include slowing, difficulty with concentration, speech and language problems, cognitive slowing, drowsiness, dizziness, difficulty with coordination, unsteadiness and fatigue. Side effects are more likely with higher starting doses and quickly increasing doses. Decreased appetite, weight loss and kidney stones have been reported. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Tranxene® (generic name: clorazepate -- clor-AZ-e-pate)
Manufacturer: Abbott Laboratories

Tranxene (TRANK-seen) is one of a group of drugs called benzodiazepines (ben-zo-di-AZE-i-peens). It is quickly absorbed after being taken by mouth, reaching peak levels 1 to 2 hours after administration. Tranxene may be prescribed as add-on medication to treat a variety of seizure types, including myoclonic and absence seizures; drop attacks and the Lennox-Gastaut syndrome. Benzodiazepines have been associated with drowsiness, slurred speech, double vision, behavior changes, dizziness, and depression among other negative effects. Effectiveness of the medication may decline over time. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Trileptal® (generic name: oxcarbazepine -- ox-car-BAZE-i-peen)
Manufacturer: Novartis Pharmaceuticals

Trileptal (Tri-LEP-tal) is related to Tegretol, TegretolXR, Carbatrol, Epitol and Atretol (carbamazepine). It was developed in an effort to combine the effectiveness of these related drugs with fewer side effects and drug interactions. Trileptal was approved for use in the treatment of epilepsy in 2000. It is used as single drug therapy and as add-on therapy in adults and children over the age of 4 with partial seizures. It tends to be better tolerated than carbamazepine with fewer side effects. It is available in tablet and liquid suspension forms. It can interact with other forms of carbamazepine and with phenobarbital, Dilantin, and Depakote. It may also reduce the effectiveness of oral contraceptives. Common side effects include fatigue, headache, dizziness, sleepiness, unsteadiness, nausea, vomiting and double vision. Allergic rashes sometimes develop, but less frequently than with carbamazepine. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Valium® (generic name: diazepam -- di-AZE-e-pam)
Manufacturer: Roche Products

Valium (VAL-I-um) is one of a group of drugs called benzodiazepines (ben-zo-di-AZE-i-peens). It is quickly absorbed after being taken by mouth, reaching peak levels 1 to 2 hours after administration. Because of its rapid entry into the brain, Valium is used in the treatment of status epilepticus (non-stop seizures). A rectal gel formulation (Diastat) is available on prescription for caregiver use against prolonged bouts of prolonged or repetitive, cluster seizures. Benzodiazepines have been associated with drowsiness, slurred speech, double vision, behavior changes and dizziness, among other negative effects. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Zarontin® (generic name: ethosuximide- eth-o-SUCKS-i-myde)
Manufacturer: Pfizer

Zarontin (Za-RON-tin), available as capsules or syrup, is a first line drug used to treat absence seizures and the drug of choice for children with absence seizures who do not have tonic-clonic or myoclonic seizures as well. The drug is effective for a typical absences, but not for myoclonic, tonic-clonic (grand mal) or partial seizures. The drug is metabolized (that is, processed) in the liver. It interacts with Depakene/Depakote and Tegretol, TegretolXR, and Carbatrol. Approximately 40 percent of patients experience side effects, with stomach pain, nausea, hiccups, vomiting, and loss of appetite being the most common. Others include drowsiness, insomnia, nervousness, dizziness, hiccups, fatigue, unsteadiness and behavior changes. Headache may sometimes occur. Allergic reactions include

various forms of rash, effects on blood, and behavior changes. Approximately 5 in every hundred children on this drug develop allergic rashes. Arriving at an effective dose may take two to three weeks. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.

Zonegran® (generic name: zonisamide -- zo-NIS-I-mide)
Manufacturer: Elan Pharmaceuticals

Zonegran (ZON-e-gran) is an anti-epileptic drug that has been available in Japan for several years. Unrelated to other seizure-preventing medications, it was approved for use in the United States as an add-on drug for adults with partial seizures in 2000. It interacts with Dilantin and Tegretol, Carbatrol and other forms of carbamazepine, Depakene/Depakote and phenobarbital. The most frequently reported side effects in clinical trials were sleepiness and fatigue. Less common side effects include kidney stones, reduced sweating, rash, loss of appetite, depression, difficulty with concentration and speech. Reports suggest this drug may have special benefit against myoclonic seizures; it is now being tested against primary generalized tonic clonic seizures. Safety in pregnancy has not been established. Women who are taking this medication and who wish to become pregnant should discuss treatment options with their physicians before the pregnancy begins.