When Anti Epileptic Drugs aggravate epilepsy

[Dutch mom]

When anti epileptic drugs aggravate epilepsy.
Genton P.
Centre Saint Paul, 13258, Marseille, France.

Paradoxically, an anti-epileptic drug (A E D) may aggravate epilepsy. The number of anti-epileptic drugs is steadily increasing, and the occurrence of paradoxical aggravation will probably become a frequent problem. The overall status of the patient treated for epilepsy can be altered due to maladjustment to the diagnosis of epilepsy, to unwanted side-effects, to overdosage and to the occurrence of tolerance. However, the main mechanism of aggravation is the occurrence of an inverse pharmacodynamic effect. The specific effect of the anti-epileptic drug is such that it controls epilepsy in most cases and increases seizures in other cases.

Idiopathic generalised epilepsies (IGE) are particularly prone to pharmacodynamic aggravation: typical absences are constantly increased bycarbamazepine (CBZ), vigabatrin, tiagabine, gabapentin, while phenytoin (PHT) is less aggravating.

Juvenile myoclonic epilepsy is often aggravated byCBZ, less constantly by PHT and other anti-epileptic drugs.

Generalised tonic-clonic seizures found in IGEs may respond to anti-epileptic drugs that aggravate the other seizure types.

In symptomatic generalised epilepsies, patients have often several seizure types that respond differently to anti-epileptic drugs: myoclonias are generally aggravated by the same drugs that aggravated IGEs; tonic seizures in the Lennox-Gastaut syndrome respond to CBZ, which may however aggravate atypical absences.

In severe myoclonic epilepsy of infancy (Dravets' syndrome), there is a nearly constant aggravating effect of lamotrigine.

In some patients with benign rolandic epilepsy, a clear aggravation may be produced by CBZ, with occurrence of negative myoclonias, atypical absences, drop attacks, and at the maximum evolution into a state of electrical status epilepticus during sleep.

It is much more difficult to pinpoint specific pharmacological sensitivity in other focal epilepsies, but aggravation clearly occurs.

Original source: http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed
I've copied this one in our Dutch forum archives (it wasn't copyrighted as far as I remember.)

[Bernard]

You missed quoting the very last sentence:

Patients are usually aware of aggravation before their doctors: we should listen carefully whenever they express a 'dislike' for an anti-epileptic drug.

If you click the link provided, there is a list of related studies/articles on the right hand side of the page.