There are different methods for treating epilepsy; among them, pharmacological treatment (antiepilepticum) is the most common and most effective method. Most types of epilepsy in children and adolescents are benign and need treatment with one antiepileptic drug (monotherapy). The treatment period may last 1-3 years. Then, in most patients, epileptic seizures never return. In patients with more severe forms of epileptic seizures, 2, 3, and sometimes more different drugs (combination therapy) are required to achieve seizure freedom or acceptable seizure situations.
The choice of preparations and combinations of them is very individual. However, today, knowledge about the mechanism of action, AED interactions, and a rule of thumb help neurologists find the appropriate medicines or combinations of them. Molecular weight, solubility (hydrophilic or lipophilic), half-life, mechanism of action, and interactions with other drugs are essential properties of antiepileptic drugs.
Drugs with a long half-life have a non-fluctuating concentration in the blood and can be given once a day. A shorter half-life is seen in higher water solubility (hydrophilic) drugs. Lower water solubility (lipophilic) is one of the properties of AEDs that make them appropriate for acute therapy of epileptic seizures. Acute antiepileptic drugs such as diazepam and midazolam have a low level of water solubility and a high level of fat solubility.
Antiepileptic drugs have different mechanisms of action, such as activating or inactivating different ion channels in nerve cells (sodium, potassium, chloride, and calcium channels), increasing or decreasing the production of different neurotransmitters (GABA, glutamine), or affecting the synapses. Therefore, the combination of drugs with different mechanisms of action provides a better therapeutic effect in patients with severe epilepsy.
Here is a list of medicines with antiepileptic properties (antiepileptics):
