Classifications of Antiepileptic Drugs | AED Overview/Topic Index | Tips on Taking or Discontinuing Antiepileptic Drugs

1.  Use [for anything] only as Directed

Like all crazy meds, antiepileptic drugs (AEDs)/anticonvulsants (ACs) are pretty versatile and are used for practically anything. Neurontin (gabapentin) is a kind of late-20th century snake oil in that it was used for almost anything a doctor or pharm rep could think of. Unlike ‘actual’ snake oil1 Neurontin works for its intended purposes and some of its off-label application. Like snake oil the FDA action and civil suits against Parke-Davis (then Warner Lambert, then Pfizer) were the first of many high-profile cases against other drug companies for similar encouragement of off-label prescribing.

Be that as it may, AEDs have plenty of uses, even if they aren’t all FDA-approved. As to the ones that are FDA-approved, there are essentially four basic categories of conditions.

2.  Epilepsy. Duh.

If you’re new to epilepsy you may want to check out these videos made by the International League Against Epilepsy (ILAE) with explanations of seizure types, along with treatment options and other good information. The ILAE is the publisher of Epilepsia. Both the organization and the publication are regarded as the gold standard when it comes to information about epilepsy. Here is a less dumbed-down version of the videos you can read.

The types of seizures the FDA approves AEDs to treat can be categorized into two overly-broad categories: generalized and partial.

2.1  Generalized Seizures

“Generalized” means “Both sides of your brain at once. Maybe everywhere, maybe enough places where it may as well be everywhere, and maybe just here and there on both sides of your brain but we’re kinda married to this definition.”

Some generalized seizures are what most people think of when they read or hear the words “epilepsy” and “seizure.” More often than not it’s the kind when you’re flopping all over the place like a fish out of water (clonic seizure), often accompanied by periods of stiff-as-a-board paralysis (tonic seizure). They’re also known by the quaint term grand mal. Another popular generalized seizure is the absence seizure, when you zone out, stare into space, and not move for several seconds to tens of minutes. This is also known as a petit mal. For more information about a way more complicated topic:

2.2  Partial Seizures

“Partial” means “A single, localized area on one side of your brain. It can be the entire hemisphere, but that’s just one side, so it’s partial. Oh, it can also spread to your entire brain.” People tend to be born with generalized seizures, while partial seizures are something you’re born with, or you get from an accident or illness, or no one has a clue as to the cause.
Partial seizures are generally divided into simple and complex.

2.3  Simple Partial Seizures

With simple partial seizures you’re still awake (more or less). Symptoms include all sorts of stuff:

  • one or two limbs spazzing out
  • wacky visual or other sensory distortions
  • strange physical sensations
  • emotional responses coming out of nowhere (e.g. sudden fear for no reason)

Simple partial seizures are frequently warnings of impending complex partial or generalized seizures. The latter are called “secondarily generalized seizures” and are lumped in with partial seizures for some reason2. This warning is known as an aura, just like migraines. I’m fortunate in that I get these with plenty of time to take some lorazepam, go to bed, and write off the day. While a complex partial seizure is no big deal (unless I break stuff), spending the day in bed sucks a lot less than having a full-on, flopping-around generalized seizure.

2.4  Complex Partial Seizures

Complex partial seizures are often a lot like sleepwalking. They may involve only some repetitive movements and/or sounds or words, or they may be like full-on, Ambien-fueled sleep-{insert activity here}. Apparently I like to walk around in circles repeating a word or phrase related to whatever I was just talking about. Also hitting something repeatedly, hence breaking stuff.

For more information:



3.  Bipolar Disorder

3.1  Bipolar 101

If you don’t know, or have just a vague idea about what bipolar is, here are some good places to start:

3.2  AEDs and Bipolar Disorder

When used to treat bipolar disorder, whether approved or not, most AEDs act as anti-manics. Lamictal (lamotrigine) is the only AED that consistently acts as a true mood stabilizer, i.e. it treats both depression and mania. Depakote (divalproex sodium) - which is approved to treat bipolar mania4 - and Keppra (levetiracetam) - which is hardly ever prescribed off-label to treat bipolar disorder - are both known to come down so hard on mania that severe depression is common side effect.

3.3  So, Is Bipolar Disorder a Form of Epilepsy?

No. It’s not. That weird hypothesis has been floating around for a long-ass time. Granted, they have a lot in common, as does depression, which is why AEDs work. And there are plenty of bipolar symptoms due to epileptic events. And more epileptics have mood disorders than non-epileptics. But all that falls under “correlation is not causation.”
The thing is, there’s practically no genetic difference between schizophrenia and bipolar disorder, and antipsychotics (APs) work to varying degrees on both. But lithium and AEDs can only help as add-ons for some schizophrenics and very rarely work alone, while APs as monotherapy will work for many of the bipolar, but sometimes they’re good only as add-ons for some of the bipolar, and sometimes they’re completely useless.

Now let’s approach it from the meds themselves. Glutamate and GABA are neurotransmitters that directly impact seizures, and most AEDs will affect either or both of those. Benzos and Gabitril are all about GABA, but it’s hit-or-miss when it comes to AEDs as mood stabilizers and GABA. Too much dopamine = seizures, and usually, but not always, mania. Too much serotonin = mania, but now they think too little serotonin lowers the seizure threshold, which is why a lot of APs, which are mostly about blocking dopamine, lower your seizure threshold. Except for lithium, which doesn’t affect serotonin and lithium is all about glutamate, unless it’s not, but either way flat-out causes seizures. AEDs affect glutamate indirectly by working on voltage channels. Without a doubt glutamate causes seizures and makes you crazy, but too little serotonin can result in depression or migraines. While a lot of people have both migraines and mood disorders, no one in their right mind would call a migraine a mood disorder5.
The meds are what really lets Occam’s Razor rip this hypothesis to shreds. If bipolar disorder were a form of epilepsy:

  • Lithium would cause mood swings, not prevent them.
  • Antipsychotics would make bipolar worse, not better6.
  • There would be more AEDs working for more of the bipolar. Pick any AED and you’ll find someone who has managed to control their bipolar symptoms with it. The success rate of that med with epilepsy is going to be a lot higher.

4.  Migraines & Other Headaches

4.1  AEDs with FDA Approval to Treat Migraines

  • Depakote (divalproex sodium)
  • Stavzor (valproic acid delayed release)
  • Tegretol (carbamazepine) - Specifically trigeminal neuralgia and glossopharyngeal neuralgia
  • Topamax (topiramate)

4.2  AEDs Used Off-label to Treat Migraines & Other Headaches

5.  Neuropathic Pain & Fibromylagia

5.1  AEDs with FDA Approval to Treat Neuropathic Pain & Fibromylagia

  • Lyrica (pregabalin)
  • Neurontin (gabapentin)
  • Tegretol (carbamazepine) - Trigeminal neuralgia and glossopharyngeal neuralgia are technically forms of excruciating neuropathic pain that just happen to be in your head.

5.2  AEDs Used Off-label to Treat Neuropathic Pain & Fibromylagia

Pretty much all of them.

6.  Less Common Off-Label Uses of AEDs



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Classifications of Antiepileptic Drugs | AED Overview/Topic Index | Tips on Taking or Discontinuing Antiepileptic Drugs


1 The fraudulent 'snake oil' sold throughout the American west of the late 19th century did not contain any snake oil. It was based upon a traditional Chinese medication that was made from snake fat.

2 My money is on the politics of taxonomy.

3 At least it's funny to those of us who are subject to all three and/or have had to figure out which one is really happening in another person.

4 While Depakene (valproic acid) is not approved to treat anything except epilepsy, only the recently-approved, delayed-release form sold under the brand name Stavzor is approved to treat bipolar disorder and migraines in addition to epilepsy. So if you're pissed off at your insurance company because they would approve only valproic acid and stuff that hasn't worked for you before, and you have nothing better to do, ask them why they'll pay for an off-label prescription in this case.

5 Although I am open to the idea that migraines are a form of epilepsy with non-convulsive seizures that last longer, hurt more, and don't offer a chance of the sweet release of death while they're happening.

6 In general as far as the bipolar population is concerned, and specifically regarding the symptoms of bipolar disorder, not the side effects of whatever antipsychotic you took. There are plenty of people for whom APs have made bipolar symptoms worse, just as there are plenty of people who have taken an AED that made their seizures worse.


Common uses of Antiepileptic Drugs (AEDs)/Anticonvulsants (ACs) by Jerod Poore is copyright © 2010
Page created by: Jerod Poore. Date created: 21 November 2010 Last edited by: JerodPoore on 2016–04–18





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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

Author: Date Modified: 2016–09–25 Date Published:

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