Antiepileptics

Valproate

Common brands: Valparin, Divaa, Encorate, Epilex, Epival syp. Common drug for most childhood epilepsies. Common side effects: Weight gain (monthly BMI monitoring), minimal hair loss (better to avoid in adolescent girl and obese patients), tremors occasionally, easy bruising due to decreased platelets. Serious side effect: liver dysfunction- rare but significant. Hence symptoms like abdominal pain, nausea, nausea, loss of appetite, jaundice needs to be looked for.

Carbamazepine

Common brands: Tegretol, Zen, Oxetol, Zeptol, Carbatol. Common Side effects: Drowsiness (initial few days, resolves later) Major side effects: Occasional skin rash, rarely exacerbation of other types of seizure (especially in young children). Therefore clinical monitoring is important for rash and new seizures.

Oxcarbamazepine

Common brands available: Oxetal, Oleptal, Trioptal, Nictal,  Oxrate, Vinlep. Side effects lesser as compared to carbamazepine. Minor side effects: Drowsiness, headache, vomiting, dizziness. Major side effects: Occasional rash, exacerbation of seizure (especially other types), high dose may lead to low sodium (leading to headache).

Levetiracetam

Common brands: Keppra, Levera, Levipil, Epifast, Epilive, Epifast, Levsam, Torleva. No life threatening side effects. Minor side effects: decreased appetite, excessive sleepiness. Major side effects: Behavioural side effects like aggression, emotional lability, oppositional behaviour and psychosis (especially in children with autism/intellectual disability etc.) May be transient. Drug has to be discontinued if significant behavioural changes noted.

Vigabatrin

Common brands: Sabril Most commonly used for infantile spasms. Major side effects: B/L peripheral visual field constriction ( rarely used in older children). Seen in 20% of children taking high dose vigabatrin for more than 6 months. Not recommended for more than 6 months.

Topiramate

Common brands: Topamac, Topaz, Epitop, Topex, Topiral. Discard the remaining ½ tablet if your doctor has prescribed ½ tablet. Use fresh tablet everytime. Good safety profile with no evidence of life threatening adverse effects. Minor side effects: dizziness, excessive sleepiness, ataxia, impaired concentration and confusion (transient, initial few weeks). Reduced by slow titration. Anorexia and mild weight loss. Major side effects: kidney stones, hyperthermia, metabolic acidosis, increased intraocular pressure.

Lamotrigine

Common brands: Lamitor, Lamictal, Lametec, Lamepil, Lamez. Please note the strength prescribed, whether 5mg or 25mg or 100mg. Minor side effects: sleep disturbance, dizziness, diplopia, nausea and vomiting, ataxia Major side effects: Usually none. However significant skin rash may prove fatal. Drug has to be discontinued if rash appears. Neurotoxicity and skin rashes commonly seen with rapid escalation or co administration with valproate. Slow titration over 2-3 months advised. Always begin with 5mg.

Phenobarbitone

Common brands: Gardenal Commonly used in those less than 2 years old. Common side effects: Sleep disturbance in infants, occasional agitation. Not preferred in school going children due to deterioration in school performance.

Phenytoin

Common brands available: Eptoin tab, Eptoin syp, Epilan, Dilantin. Common side effects: cosmetic side effects, gum hypertrophy (oral hygiene must), fluctuating levels (requires frequent drug level monitoring). Almost never a first choice in those less than 10 years. Use limited mostly to acute setting.

Zonisamide

Common brands: Zonegran, Zonicare, Zonimid, Zonit, Zonisep.  Common side effects: excessive sleepiness, anorexia Rarely Acute pancreatitis, hypersensitivity reactions, kidney stone formations. It is advised to maintain good fluid intake.

Clobazam

Common brands: Lobazam, Frisium, Clodus, Cloba, Clobator Common side effects: Sedation, somnolence, aggression and irritability sometimes.  Serious side effects: skin rashes, behavioural issues.

Midazolam nasal spray

Common brands: Midacip, Insed, Medistat. A very useful and effective drug for children when seizure lasts for more than 5 minutes. Safe in prescribed doses Common side effects: Drowsiness common. Respiratory depression may result if given in higher doses.