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CC BY-NC-ND 4.0 · International Journal of Epilepsy 2025; 11(01): 004-012
DOI: 10.1055/s-0045-1802582
Review Article

Antiseizure Medication in the Setting of Systemic Illness: A Focused Review

Bindu Menon
1   Department of Neurology, Apollo Speciality Hospitals, Nellore, Andhra Pradesh, India
,
Medha Menon
2   Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
,
Praveen Kumar Yadav
3   Sri Ramakrishna Mission Medical College (SRIMS), Durgapur, general Medicine West Bengal, India
,
Mainak Bardhan 
4   Miller School of Medicine, Human Genetics University of Miami, Miami, Florida, United States
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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


Publikationsverlauf

Artikel online veröffentlicht:
12. Februar 2025

© 2025. Indian Epilepsy Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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