How anticonvulsants work
The brain is made up of billions of neurons that are constantly firing electrical signals, allowing information to be relayed from one part of the brain to another. Seizures occur when neurons become “over-excited” and start firing signals at a much faster rate than normal.
Anticonvulsants work to reduce neuron excitability — essentially and effectively “calming the brain.” While there are several types of anticonvulsants, all generally either target ion channels (molecules that allow the movement of substances in and out of brain cells) or neurotransmitters (chemical messengers in the brain).
Anticonvulsants are not able to cure a person of seizures or stop those that have already started. Rather, they aim at preventing seizures from occurring. They are usually chosen based on previous experience, and what was effective in other patients with similar seizure patterns.
Anticonvulsants for Dravet syndrome
Anticonvulsants that are often considered first for Dravet syndrome patients are Depacon (sodium valproate), Topamax (topiramate), Onfi (clobazam), and Diacomit (stiripentol). Other medications, such as clonazepam and Zonegran (zonisamide) may also be used.
Certain types of anticonvulsants — such as Lamictal (lamotrigine), Dilantin (phenytoin), Tegretol (carbamazepine), and Trileptal (oxcarbazepine) — which target sodium channels are generally avoided in Dravet patients as they may worsen seizures.
The seizures in Dravet syndrome are known to be very resistant to treatment. Patients often need to be on three different types of anticonvulsants to control their seizures.
It is important for anticonvulsant medications to be taken consistently to achieve seizure control. Missing a dose of anticonvulsant medication can leave patients at a higher risk of seizures and treatment side effects; consistent and regular use as prescribed is important.
General side effects
Patients taking anticonvulsants should be monitored closely, as these medications often carry side effects and can impact a person’s quality of life.
The most common of these include fatigue, sedation, mental ‘slowing down,’ tremors, tingling sensations or numbness, and changes in mood and behavior.
Patients are also at risk of developing side effects that occur unpredictably and without warning (known as idiosyncratic reactions). These side effects may target the skin, liver, bone marrow (resulting in blood abnormalities), and the pancreas.
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