Aggravation of epilepsy by anti-epileptic drugs

Gayatri, NA; Livingston, JH

doi:10.1017/s0012162206000843

Cited by 114Epilepsy research and treatmentPharmacological Effects and Toxicity StudiesDrug-Induced Adverse Reactions

Aggravation of epilepsy by anti-epileptic drugs

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Gayatri, NA, Livingston, JH·2006·Developmental Medicine & Child Neurology

DOI 10.1017/s0012162206000843

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Abstract

The possibility that so‐called anti‐epileptic drugs (AEDs) may aggravate epilepsy must always be borne in mind by the clinician. Many reports of such aggravation of seizures have been published. Most such reports are anecdotal and speculative, and suggest that many such reactions are idiosyncratic. However, for some there is a sufficient body of evidence to suggest that some AEDs used in certain epilepsies may consistently cause worsening of seizures. Seizure aggravation may include increase in the frequency or severity of existing seizures, emergence of new types of seizure, or the occurrence of status epilepticus. The pathophysiology of seizure aggravation is poorly understood including nonspecific effects such as those associated with sedation, druginduced encephalopathy, and paradoxical or inverse pharmacodynamic effects. For some epilepsies the choice of AEDs may be inappropriate, and although the mechanism of seizure aggravation is not clear, its occurrence may be fairly predictable. This is best documented for the use of carbamazepine in idiopathic generalized and myoclonic epilepsies. Most other AEDs have been reported occasionally to cause seizure aggravation. The lowest risk of seizure aggravation appears to be with valproate. Risk factors for worsening of seizures are epileptic encephalopathy, polytherapy, high frequency of seizures, and cognitive impairment. Advances in pharmacogenomics may in the future enable such adverse effects to be predicted for individual patients. Meanwhile, a systematic approach to reporting AED‐induced seizure aggravation should be developed.

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Paradoxical excitement is sometimes associated with benzodiazepine use and may include exacerbation of seizures in patients with epilepsy.
“Paradoxical excitement is sometimes associated with BZD use and may include exacerbation of seizures in patients with epilepsy (171).”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [171]

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Authors: Gayatri, N., & Livingston, J.
Affiliations: Leeds Teaching Hospitals NHS Trust (GB)
Corresponding author: Gayatri, NA
Venue: Developmental Medicine & Child Neurology
Publisher: Wiley
Published: 2006-05
Volume: 48
Issue: 5
Pages: 394-398
ISSN: 0012-1622 (ISSN-L)
1469-8749
DOI: 10.1017/s0012162206000843
OpenAlex: W2150292807
Cited by: 114
References: 45
Citations by year: 2026: 3 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 3 · 2017: 9 · 2016: 5 · 2015: 8 · 2014: 10 · 2013: 4 · 2012: 8
FWCI: 0.83
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 305 d)
Locations: Developmental Medicine & Child Neurology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
Keywords: antiepileptic drugs, adverse drug reactions, carbamazepine, idiopathic generalized epilepsy, myoclonic epilepsy, valproic acid, status epilepticus, paradoxical drug reaction, drug-induced encephalopathy, pharmacogenomics, risk factors, seizure frequency
MeSH terms: Anticonvulsants, Child, Epilepsy, Humans, Severity of Illness Index, Prevalence

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