Lamotrigine Clonazepam

Myoclonic Not mentioned Lamotrigine Valproate Valproate Topiramate (children with severe myoclonic epilepsy of infancy) Second-line Clobazam6 Clonazepam Lamotrigine Levetiracetam Piracetam6 Topiramate... 

Myoclonic Valproic acid, clonazepam Lamotrigine, topiramate, felbamate... 

For generalized absence seizures, first line treatment is with valproate or ethosuximide and second line treatment with acetazolamide, clobazam, clonazepam, lamotrigine, phenobarbitone and primidone. 

Drugs that may affect valproic acid include carbamazepine, charcoal, chlorpromazine, cholestyramine, cimetidine, erythromycin, ethosuximide, felbamate, lamotrigine, phenytoin, rifampin, and salicylates. Drugs that may be affected by valproic acid include carbamazepine, clonazepam, diazepam, ethosuximide, lamotrigine, phenobarbital, phenytoin, tolbutamide, tricyclic antidepressants, warfarin, and zidovudine. 

At least three drugs are effective against absence seizures. Two are nonsedating and therefore preferred ethosuximide and valproate. Clonazepam is also highly effective but has disadvantages of dose-related adverse effects and development of tolerance. Lamotrigine and topiramate may also be useful. 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

For simple and complex partial seizures and secondary generalized tonic-clonic seizures, the first line drugs are - carbamazepine, valproate and phenytoin. Second line drugs include - acetazolamide, clobazam, clonazepam, ethosuximide, felbamate, gabapentin, lamotrigine, levetiracetam, oxacarbamazepine, primidone, tiagabine, topiramate and vigabactin. 

Myoclonic seizures are best treated with valproate but, as a second choice, with clobazam, clonazepam, ethosuximide, lamotrigine, phenobarbitone, piracetam or primidone. 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

Individual drugs carbamazepine, phenytoin, sodium valproate, lamotrigine, vigabatrin, gabapentin, clonazepam, topiramate, levetiracetam. 

Phenobarbital Phenytoin Primidone Felbamate Lamotrigine Tiagabide Topiramate Valproate Zonisamide Clobazam Clonazepam Diazepam usually compensated by the effect of the added drug risk of toxicity when interfering drug is discontinued drug... 

Myoclonic syndromes Myoclonic seizure syndromes are usually treated with valproic acid. Clonazepam can be effective, but the high doses required cause drowsiness. Lamotrigine is also reported to be effective in myoclonic syndromes in children. Felbamate has been used adjunctively with the primary drugs but has hematotoxic and hepatotoxic potential. 

Both forms of absence seizure often occur as part of one of the recognized epilepsy syndromes. Typical absence seizures respond fairly well to AEDs ethosuximide and valproate are first-choice drugs. Clonazepam is effective but sedating, and tolerance to the antiabsence effects may develop. Lamotrigine may be useful. Treatment of atypical absence seizures with AEDs Is less successful. 

Lennox-Gastaut syndrome is a mixed seizure disorder combining the atypical absence seizures with tonic, tonic-clonic, or myoclonic motor patterns. The syndrome begins in childhood and usually Includes mental retardation. Although adequate control of the seizures rarely Is achieved, valproate, phenytoin, felbamate, lamotrigine, topiramate, and clonazepam have been... 

Myoclonic seizures consist of sudden, very brief, jerking contractions that may involve the entire body or be confined to limited areas, such as the face and neck. The contractions may affect Individual muscles or groups, with simultaneous contraction of both extensor and flexor muscles. These seizures occur In all age groups, with symptoms ranging from rapid tremors to falling down. No loss of consciousness Is detectable because of the brief duration of the seizure. Myoclonic seizures often occur In combination with other seizure types. Valproate and clonazepam are used most often to treat myoclonic seizures lamotrigine and topiramate also have shown some efficacy. 

Clonazepam (Klonopin) was approved in 1975 for monotherapy or adjunctive treatment of akinetic (atonic), myoclonic, and absence variant seizures (64). Clonazepam also was found to be effective in controlling absence seizures, but because of the high incidence of side effects. It Is rated second to ethosuximide. It may be useful, however. In absence seizures when succinimide therapy has failed. It Is considered to be a third-line drug after 1) ethosuximide or valproate and 2) lamotrigine or valproate for the treatment of absence seizures. It is ineffective for treatment of generalized clonic-tonic seizures. 

Clonazepam and valproate commonly are used to control myoclonic seizures. Studies suggest that lamotrigine and topiramate may be effective as well, although neither is approved by the U.S. FDA for this indication. 

Phenobarbital, phenytoin and carbamazepine can cause a small to moderate reduction in the serum levels of zonisamide, while lamotrigine may increase zonisamide levels. Clonazepam and valproate have little or no effect. Zonisamide shows variable effects (a modest decrease, an increase, or no effect) on carbamazepine serum levels, but has no important effect on lamotrigine, phenobarbital, primidone or valproate levels. Most studies also suggest that zonisamide has no effect on phenytoin levels, but two showed a modest increase. 

The use of benzodiazepines with antiepileptics is common and possibly accompanied by some changes in serum levels, which are normally of limited clinical importance. However, isolated interactions have been reported between chlordiazepoxide or cloba-zam and phenobarbital between clonazepam and lamotrigine or primidone and between clorazepate and primidone. 

The plasma clonazepam levels in 4 of 8 patients fell by about 38% when they were also given lamotrigine. ... 

None of the interactions between the benzodiazepines and antiepileptics described here appear to be of major clinical importance, with the possible exception of the interaction between clobazam and felbamate. If both drugs are given be aware that additive sedative or other adverse effects may occur. This may also be possible in some rare cases with chlordiazepoxide or clobazam and phenobarbital clonazepam and lamotrigine or primidone and clorazepate and primidone. 

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