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Table 3 Selected anti-epileptic drugs (and alternatives to valproate in the treatment of epilepsy), adapted from Schmidt and Schachter [10]

From: Sodium valproate in pregnancy: what are the risks and should we use a shared decision-making approach?

Class of drug Name of drug Proposed mechanism Side effects Additional information
1st generation Phenytoin Sodium channel blocker Enzyme inducer (hence interaction with other medications), skin hypersensitivity First line for focal and generalised seizures with focal onset
Ethosuxamide T-type calcium channel blocker Gastrointestinal side effects, insomnia, psychosis First line for absence seizures
2nd generation Carbamazepine Sodium channel blocker Enzyme inducer, skin hypersensitivity First line for focal and generalised seizures with focal onset
Valproate GABA potentiation, blocks voltage gated sodium channels, epigenetically inhibits histone deacetylase GI upset, weight gain, tremor, hair loss with curly regrowth, teratogenicity (see Table 4)
In women: polycystic ovarian syndrome, hyperandrogenism
Rare: fulminant liver failure
First line for focal and generalised seizures, no skin hypersensitivity, no newer drugs have been shown to have higher efficacy
3rd generation Vigabatrin GABA potentiation Visual defects, weight gain, seizure aggravation, encephalopathy Use in infantile spasms, adjunct in complex partial seizures
Lamotrigine GABA potentiation, suppresses glutamate release, inhibits serotonin reuptake Tremor, dizziness, tiredness, loss of co-ordination, menstrual disturbance, dry mouth, sleep problems First line for focal and generalised seizures, lower efficacy than valproate for absence seizures
Oxcarbazepine Sodium channel blocker Enzyme inducer, hyponatraemia, skin hypersensitivity First line for focal and generalised seizures with focal onset
Gabapentin Calcium channel blocker Weight gain, psychosis, seizure aggravation, tiredness, dizziness Adjunctive use only, used in focal and generalised seizures with focal onset
Levetiracetam SV2A modulation Tiredness, dizziness, behavioural problems First line in focal and generalised seizures with focal onset and myoclonic seizures.
Topiramate GABA potentiation, glutamate inhibition, sodium/calcium channel blocker Tiredness, dizziness, skin hypersensitivity, weight loss, teratogenicity First line for focal and generalised seizures