Cerebral Palsy and Seizure Medications

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Seizures are an associated condition for many children with cerebral palsy. Seizure medications, also known as anti-epileptic medications, often play a significant role in helping to reduce and control seizures. Although they can be beneficial, there are some risks and side effects.

About Anti-Epileptic and Seizure Medications

Anti-epileptic medications, also referred to as anticonvulsants, work by reducing excessive brain stimulation. They calm hyperactivity in the child’s brain, which reduces and controls seizure activity.

The National Institute of Neurological Disorders and Stroke (NIH) reports that there are over 20 different types of anti-epileptic medications. The kind your child may be prescribed will depend on age, health history, and the type of seizures that need to be treated.

Additionally, there is often a trial and error period until your physician can figure out the medication that benefits your child the most.

Phenobarbital

Phenobarbital (narrow-spectrum) is a common anti-seizure medication prescribed to children. Also known as phenobarbitone, this type of medication can be used to treat all types of seizures, aside from absence seizures.[1] Phenobarbital can be administered via an IV, taken orally, or injected with a syringe.

As with most medications, phenobarbital may result in side effects, with the most common including:

• Dizziness
• Excitement
• Confusion
• Hallucinations
• Trouble with sleeping
• Low blood pressure
• Constipation

In most instances, physicians will start children on a low dose of the medication, which can be increased if needed. It generally takes several weeks before the full effects of phenobarbital can be seen.

Clonazepam

Clonazepam (broad-spectrum), also known as Klonopin, is a benzodiazepine medication used to treat anxiety, panic disorders, and seizures.

When prescribed to treat seizures, the medication works by affecting the chemicals in the brain, resulting in a decreased amount of seizure activity.[2]

Side effects can include:

• Dizziness
• Ear congestion
• Body pains
• Fatigue
• Poor appetite
• Poor coordination
• Sore throat, coughing, and sneezing
• Irritability
• Feeling empty or discouraged

Dilantin

Phenytoin, also known as Dilantin (broad-spectrum), is an anti-seizure medication in the anticonvulsant class of drugs.[3]

Although Dilantin controls and reduces seizures, it doesn’t work for absence seizures. However, it’s been proven effective for children who experience partial seizures or tonic-clonic seizures.

Side effects may include:

• Nausea
• Abdominal pain
• Poor appetite
• Poor coordination
• Low blood pressure
• Drowsiness
• Headaches
• Excitability
• Vomiting

Dilantin is taken by mouth, either once a day or divided into 2-3 times a day, depending on how severe the seizures are. Doctors generally recommend that children take the medication with food to help prevent stomach pain.

Each dosage should be taken at the same time each day and with a full glass of water unless your child’s physician indicates otherwise.

Valproic Acid

Valproic acid (broad-spectrum) is used to treat seizures, migraine headaches, and mood disorders.[4] It’s prescribed in capsule form, gel form, sprinkles, or liquid.

Side effects may include:

• Abdominal pain
• Nausea and vomiting
• Dizziness
• Double vision
• Decreased appetite
• Poor coordination
• Slurred speech

Valproic acid comes in many different names, including:

• Depakote
• Depakene
• Epival
• Valproate

Since this medication causes interactions with other drugs, your physician will need a complete list of any other medicines that your child takes. Valproic acid can also be habit-forming.

Carbamazepine

Carbamazepine (narrow-spectrum), also known by its brand name Tegretol, is an anticonvulsant medication primarily used to treat seizures. It is also prescribed for bipolar disorder and nerve pain. For seizures, this medication works best on partial, tonic-clonic, and mixed.[5]

Side effects may include:

• Drowsiness
• Dizziness
• Poor coordination
• Fainting
• Breath shortness
• Sore throat
• Bruising
• Fatigue
• Skin blistering and more prone to sunburns
• Abdominal pain

Tegretol is available in tablet form (including extended-release or chewable tablets) or suspension. It should be taken at the same time each day unless your child’s doctor specifies otherwise. In addition, giving the medicine with food will help reduce the chances of your child developing abdominal pain.

Lorazepam

Lorazepam (broad-spectrum), also known by its brand name Ativan, helps stop seizures and reduce muscle spasms.[6] This type of medication is typically given only when the child needs it and comes in tablet form, syrup form, or via injection.

Side effects may include:

• Drowsiness and fatigue
• Weakness
• Slurred speech
• Slowed heartbeat
• Shortness of breath
• Abdominal pain
• Agitation

Other medications may react with Lorazepam, including over-the-counter cough medications. Be sure to let your child’s physician know about any medications beforehand.

Seizure Medication Categories and Additional Options

The two major types of seizure medications are broad-spectrum and narrow-spectrum. Narrow-spectrum seizure medications are generally known for their affordability and efficacy in certain types of seizures, such as partial seizures or focal seizures.

However, narrow-spectrum drugs will not work on all types of seizures and only on one particular part of the brain. Each medication comes with side effects that some children may find difficult to handle. The most common narrow-spectrum medications include:

• Vigabatrin (Sabril). This treats partial-onset seizures but is usually prescribed to people over 17. Side effects include dizziness, shakiness, sleepiness, nausea, and trembling.
• Lacosamide (Vimpat). One of the newer seizure medications, Vimpat, works well for partial seizures. Side effects include headaches, dizziness, lethargy, and nausea.
• Oxcarbazepine (Trileptal). Generally more expensive than other narrow-spectrum medications but works well for partial seizures. Side effects include nausea, dizziness, and diplopia.
• Pregabalin (Lyrica). Lyrica works well for partial-onset seizures but can include side effects of swelling, drowsiness, rash, hives, and trouble breathing.
• Gabapentin (Neurontin). Gabapentin treats complex partial seizures and simple partial seizures. Side effects can include drowsiness, dizziness, swelling, and weight gain.
• Diazepam (Valium or Diastat). Diazepam works well for cluster seizures and prolonged seizures, but side effects may include clouded judgment, poor motor skills, the potential for dependence, drowsiness, muscle weakness, headaches, and tremors.
• Eslicarbazepine Acetate (Aptiom). This medication is primarily used to treat partial-onset seizures. It comes with possible side effects of diplopia, nausea, dizziness, headaches, vomiting, and fatigue.

Broad-spectrum seizure medications are used to treat more than one type of seizure. They prevent or reduce the types of seizures in more than one area of the brain. The most commonly-prescribed broad-spectrum medications include:

• Topiramate (Topamax). Although it’s considered a strong and effective medication for seizures, it can cause cognitive issues, weight gain, kidney stones, and language problems. It’s said to be prescribed to a child with seizures who are obese, despite the potential for weight gain as a side effect.
• Lamotrigine (Lamictal). Used to treat a variety of different types of seizures. Side effects can include dizziness, headaches, sleepiness, blurred vision, nausea, and tremors.
• Rufinamide (Banzel). A newer medication, this is mainly used for patients who have  Lennox-Gastaut syndrome and seizures. Side effects may include headaches, nausea, fatigue, and dizziness.
• Levetiracetam (Keppra). Keppra commonly treats seizures in both children and adults. Side effects may include weakness, confusion, headache, vomiting, constipation, and sleepiness.
• Zonisamide (Zonegran). Zonisamide is generally used in combination with other medications to help control seizures. Side effects can include dizziness, coordination problems, diarrhea, sleep problems, and poor appetite.

Experts indicate that there isn’t a single seizure medication that dominates the other medications in efficacy. Each child is unique and will respond to drugs differently. They’ll also respond to side effects differently.

While some children will experience severe side effects with one medication, they may experience few, if any, side effects with a different seizure medication.

It’s also important to note that the side effects listed above, next to each medication, are only a few of the most common ones, and the drugs may have additional side effects.  It’s crucial to talk in-depth with your child’s physician before choosing a seizure medication.

When Medications Don’t Control Seizures

Sometimes a doctor will prescribe numerous medications, yet none seem to work. In these instances, physicians will try to find other measures to help control seizures, which may include:

Vagal Nerve Stimulation

Vagal nerve stimulation (VNS) is a medical technique in which a pacemaker is implanted to stimulate the vagal nerves. When the vagal nerve is stimulated, seizures can decrease in frequency.

Diet

Diet can play an integral role in helping children reduce seizures.  Diets that focus on low carbohydrate foods, such as The Ketogenic Diet or The Modified Atkins Diet, may be recommended.

Surgery

Surgery may be recommended when all other options fail. Typically, surgery is reserved for cases in which a child has seizures that occur due to an issue in a particular part of the brain.

If your child has seizures, talk to your doctors about finding the right treatment, whether or not it includes medications.