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Anticonvulsants are a large group of medications used in prevention of the occurrence of epileptic seizures, also known as anti-epileptics.

Although they’ve initially been used only to treat epileptic episodes, today they are also seen as mood stabilizers. It has been proven that anticonvulsants can help in treatment of the bipolar disorder.


An epileptic attack is a consequence of rapid and excessive firing of neurons that start a seizure. Anticonvulsants prevent this, and thereby contain the spread of the seizure within the brain, and possible brain damage. There are several possible mechanisms of action: some of them block Sodium (Na+) channels and Calcium (Ca2+) channels, while some block AMPA receptors or NMDA receptors. Some anticonvulsants inhibit the metabolism of GABA or increase its release.

Anticonvulsants most commonly used are barbiturates and benzodiazepines. Instead of using only one drug, people often take two or more anticonvulsant medications to prevent seizures;  possible interaction may cause several health problems

Types of seizures treated with anticonvulsants

A seizure is a synchronized depolarization of brain cells. It affects parts of the brain, or sometimes the whole cortex. The seizure mechanism is the only way the brain can defend itself against outer influences!

There are four different seizure types, each with its own characteristic symptoms:

  • Petit Mal
  • Grand Mal (Generalized Tonic Clonic)
  • Single Focal
  • Partial Complex


Petit mal

  • minimal or no movements
  • an appearance like a blank stare
  • brief sudden loss of awareness or conscious activity  
  • recurring many times throughout childhood
  • decreased learning


Grand mal

  • generalized, violent muscle contractions  
  • patient emitting a sudden cry
  • breathing stopping temporarily
  • loss of consciousness
  • weakness
  • stupor
  • headache
  • confusion
  • incontinence of urine
  • tongue or cheek biting


Single focal

  • muscle contractions of a specific body part
  • abnormal sensations  
  • nausea
  • sweating
  • skin flushing
  • dilated pupils
  • other focal (localized) symptoms


Partial complex

  • automatism
  • nausea
  • sweating
  • skin flushing
  • dilated pupils
  • loss of consciousness
  • changes in personality  


Most commonly used anticonvulsants and their side effects:

Drug name

Drug class/structure

Common side effects

phenytoin (Dilantin®)

Hydantoin

Dizziness, drowsiness, confusion, Ataxia, nausea, gingival hyperplasia, megaloblastic anemia, leukopenia

carbamazepine

(Epitol®, Tegretol®)

Tricyclic

Sedation, dizziness, fatigue, confusion, ataxia, nausea, blood, dyscrasias, hepatotoxicity

valproic acid

(Depakene®, Depakote®)

Carboxylic acid

Anorexia, diarrhea, nausea, drowsiness, ataxia, irritability, confusion, headache, leucopenia, thrombocytopenia, hepatotoxicity, prolonged bleeding time

ethosuximide

(Zarontin®)

Succinimide

Ataxia , sedation, dizziness, hallucinations, behavioral changes, headache, Stevens-Johnson syndrome, systemic lupus, erythematosus, nausea, anorexia

clonazepam

(Klonopin®)

Benzodiazepine

Tachycardia, drowsiness, fatigue, anxiety, ataxia, headache, dizziness, blurred vision, Xerostomia

primidone

(Mysoline®)

Barbiturate derivative

Drowsiness, vertigo, ataxia, behavioral changes, headache, nausea

Phenobarbital

(Barbita®, Luminal®,

Solfoton®)

Barbiturate

Dizziness, lightheadedness, sedation, ataxia, impaired judgment, skin rashes

Anticonvulsants as mood stabilizers

Mood stabilizers are medications used to treat mood disorders, especially bipolar disorder. They are used to treat the depressive part of this disorder (which also has a manic part, of course.) Anticonvulsants also used as mood stabilizers include valproic acid and carbamazepine. There are several theories regarding their mechanism of function, and the most probable is the one that claims they regulate the glutamate excitatory neurotransmission and GABA inhibitory neurotransmission. Studies have shown that they also have certain intracellular effects such as modulation of the activity of enzymes, ions, arachidonic acid turnover, G-protein coupled receptors, and intracellular pathways involved in synaptic plasticity and neuroprotection. 

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