Abstract
Epilepsy is a common neurological disorder, and managing seizures can be challenging
when other systemic illnesses are present, as these can affect the choice of antiseizure
medication (ASM). Various comorbidities, such as cardiovascular disorders, liver and
kidney impairment, psychiatric conditions, porphyria, and thyroid dysfunction, can
significantly influence the pharmacokinetics and pharmacodynamics of ASMs. This requires
careful selection of suitable ASMs based on their safety profiles and potential for
drug interactions. Traditional ASMs such as phenytoin, carbamazepine, and valproate
should be taken cautiously in individuals with cardiovascular disorders because of
the possibility of side effects. Conversely, newer medications like lamotrigine and
lacosamide (LCM) may offer safer alternatives. Levetiracetam and LCM are examples
of medications with minimal hepatic metabolism, which are recommended since hepatic
dysfunction can impact the binding potential of ASMs and result in toxicity. Furthermore,
drugs that are mostly eliminated by the kidneys may take longer to be eliminated due
to renal impairment, necessitating dose adjustments or the consideration of alternate
therapies. ASMs can also affect psychiatric conditions; some medications may provide
mood-stabilizing or antidepressant effects, while others may worsen psychiatric symptoms.
Certain ASMs can trigger porphyria or disrupt thyroid function, necessitating careful
monitoring and appropriate selection of treatments. This review offers a comprehensive
overview of considerations and recommendations for the use of ASMs in various systemic
illnesses, highlighting the need for a sophisticated strategy to maximize managing
seizures while reducing side effects and medication interactions.
Keywords
epilepsy - antiseizure medications (ASMs) - systemic illnesses - pharmacokinetics
- safety profiles
