Epilepsy
Chronic brain disorder with recurrent unprovoked epileptic seizures. May be focal (one area) or generalised (both hemispheres).
ICD-10 G402 drugs
Also known as: Seizure disorder, Convulsions
Drugs used for this condition
- AValproic acidFirst line · Antiepileptics. Fatty acid derivativesValproic acid is first-line antiepileptic for generalised epilepsy (tonic-clonic, absence, myoclonic seizures) and effective in focal seizures. ILAE 2017 and SEN recommend as first choice in men and postmenopausal women. In women of childbearing age EMA imposed strict restriction since 2018 due to high teratogenic risk (mandatory pregnancy prevention programme).
- BPhenytoinSecond line · Antiepileptic, hydantoin derivative (sodium channel blocker)Phenytoin is a second-line antiepileptic for focal and generalised tonic-clonic seizures in adults when levetiracetam, lamotrigine or oxcarbazepine fail. The narrow therapeutic window (10–20 mcg/mL) and non-linear kinetics require blood level monitoring. ILAE 2017 and SEN moved phenytoin off first-line because of gingival hyperplasia, hirsutism, long-term osteopenia and drug hypersensitivity syndrome.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit