Advances in pharmacotherapy for adult epilepsy

doi:10.12092/j.issn.1009-2501.2026.02.001

Abstract

Abstract:

Epilepsy is a kind of common chronic nervous system disease, with approximately 70% of patients achieving seizure free through antiseizure medications (ASMs). Recent years have witnessed significant advancements in the pharmacological treatment of adult epilepsy, marked by the emergence of novel antiepileptic drugs. Special populations, including women of childbearing age and older adults with epilepsy, have garnered increased clinical attention. This review summarizes recent research progress in drug therapy for adult epilepsy, aiming to provide evidence-based references for more individualized and effective treatment strategies.

Key words: adult, epilepsy, pharmacotherapy

CLC Number:

R742.1

Yiling CHEN, Guoxing ZHU. Advances in pharmacotherapy for adult epilepsy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(2): 146-153.

Figures/Tables 1

References 57

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ASMs	Seizure type	Mechanism	Common adverse effects	Effects on hepatic enzymes
First generation
PHB	FOS and GTCS	Increases GABA levels	Fatigue, somnolence, depression, impaired attention, hyperactivity, irritability, aggressive behavior, memory impairment	Inducer
PHT	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker	Nystagmus, ataxia, anorexia, nausea, vomiting, aggressive behavior, megaloblastic anemia	Inducer (CYP1A2, CYP3A, CYP2C9, CYP2C19, PGP, UGT)
CZP	Myoclonic-atonic seizures	Enhances GABA_A mediated inhibition	Sedation, ataxia, irritability, occasional leukopenia	-
CBZ	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker	Diplopia, dizziness, nausea, drowsiness, hyponatremia, neutropenia, osteoporosis	Inducer (CYP1A2, CYP3A, CYP2C9, CYP2C19, PGP, UGT)
VPA	FOS, GTCS, absence seizures, myoclonic seizures	Sodium channel blocker, enhances GABA, T-type calcium channel blocker	Nausea, vomiting, drowsiness, tremor, thrombocytopenia/neutropenia, weight gain, osteoporosis, pancreatitis	Inhibitor (CYP2C9, epoxide hydrolase, UGT)
Second generation
GBP	FOS (may worsen myoclonic seizures)	P/Q-type calcium channel blocker	Somnolence, dizziness, ataxia, fatigue, weight gain, peripheral edema	-
LTG	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker, may increase GABA levels	Headache, blurred vision, diplopia, instability, insomnia, tremor, rash	Inducer (UGT) Inhibitor (UGT, CYP2C19)
TPM	FOS, GTCS	Sodium channel blocker, may enhance GABA activity, AMPA receptor antagonist	Sedation, fatigue, dizziness, ataxia, depression, weight loss, memory impairment, word-finding difficulties, kidney stones	Weak inducer (CYP3A4) Weak inhibitor (CYP2C19)
LEV	FOS, GTCS, myoclonic seizures	Binds to SV2A protein	Somnolence, dizziness, weakness, irritability	-
OXC	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker	Drowsiness, headache, fatigue, hyponatremia, osteoporosis	Weak inducer (CYP3A4) Weak inhibitor (CYP2C19)
ZNS	FOS, Generalized seizures, myoclonic seizures	Blocks sodium and calcium channels, weak carbonic anhydrase inhibitor	Psychiatric symptoms, memory impairment, word-finding difficulties, kidney stones	-
Third generation
LCM	FOS, GTCS	Slow sodium channel inactivation	Dizziness, somnolence, nausea, diplopia, cardiac arrhythmias	-
PER	FOS, GTCS	AMPA receptor antagonist	Dizziness, somnolence, nausea, falls	Weak inhibitor/inducer (CYP3A4)
ESL	FOS	Blocks sodium channels, stabilizes the inactive state of voltage-gated sodium channels	Dizziness, somnolence, headache, diplopia, nausea, ataxia	Weak inhibitor (CYP2C19) Weak inducer (CYP3A4)
BRV	FOS	Binds to SV2A	Somnolence, dizziness, fatigue, irritability	-

ASMs	Seizure type	Mechanism	Common adverse effects	Effects on hepatic enzymes
First generation
PHB	FOS and GTCS	Increases GABA levels	Fatigue, somnolence, depression, impaired attention, hyperactivity, irritability, aggressive behavior, memory impairment	Inducer
PHT	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker	Nystagmus, ataxia, anorexia, nausea, vomiting, aggressive behavior, megaloblastic anemia	Inducer (CYP1A2, CYP3A, CYP2C9, CYP2C19, PGP, UGT)
CZP	Myoclonic-atonic seizures	Enhances GABA_A mediated inhibition	Sedation, ataxia, irritability, occasional leukopenia	-
CBZ	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker	Diplopia, dizziness, nausea, drowsiness, hyponatremia, neutropenia, osteoporosis	Inducer (CYP1A2, CYP3A, CYP2C9, CYP2C19, PGP, UGT)
VPA	FOS, GTCS, absence seizures, myoclonic seizures	Sodium channel blocker, enhances GABA, T-type calcium channel blocker	Nausea, vomiting, drowsiness, tremor, thrombocytopenia/neutropenia, weight gain, osteoporosis, pancreatitis	Inhibitor (CYP2C9, epoxide hydrolase, UGT)
Second generation
GBP	FOS (may worsen myoclonic seizures)	P/Q-type calcium channel blocker	Somnolence, dizziness, ataxia, fatigue, weight gain, peripheral edema	-
LTG	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker, may increase GABA levels	Headache, blurred vision, diplopia, instability, insomnia, tremor, rash	Inducer (UGT) Inhibitor (UGT, CYP2C19)
TPM	FOS, GTCS	Sodium channel blocker, may enhance GABA activity, AMPA receptor antagonist	Sedation, fatigue, dizziness, ataxia, depression, weight loss, memory impairment, word-finding difficulties, kidney stones	Weak inducer (CYP3A4) Weak inhibitor (CYP2C19)
LEV	FOS, GTCS, myoclonic seizures	Binds to SV2A protein	Somnolence, dizziness, weakness, irritability	-
OXC	FOS, GTCS (may worsen myoclonic seizures)	Sodium channel blocker	Drowsiness, headache, fatigue, hyponatremia, osteoporosis	Weak inducer (CYP3A4) Weak inhibitor (CYP2C19)
ZNS	FOS, Generalized seizures, myoclonic seizures	Blocks sodium and calcium channels, weak carbonic anhydrase inhibitor	Psychiatric symptoms, memory impairment, word-finding difficulties, kidney stones	-
Third generation
LCM	FOS, GTCS	Slow sodium channel inactivation	Dizziness, somnolence, nausea, diplopia, cardiac arrhythmias	-
PER	FOS, GTCS	AMPA receptor antagonist	Dizziness, somnolence, nausea, falls	Weak inhibitor/inducer (CYP3A4)
ESL	FOS	Blocks sodium channels, stabilizes the inactive state of voltage-gated sodium channels	Dizziness, somnolence, headache, diplopia, nausea, ataxia	Weak inhibitor (CYP2C19) Weak inducer (CYP3A4)
BRV	FOS	Binds to SV2A	Somnolence, dizziness, fatigue, irritability	-

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