Antiepileptic Drug Therapy and Pharmacological Interactions
Summary
Antiepileptic drug therapy remains the cornerstone of epilepsy management, with more than 25 antiseizure medications (ASMs) available to tailor treatment to seizure type, patient comorbidities and lifestyle considerations. Monotherapy is preferred for its simplicity and reduced risk of interactions, yet approximately one-third of patients require polytherapy to achieve seizure control. Drug–drug interactions may be pharmacokinetic, involving altered absorption, distribution, metabolism or excretion, or pharmacodynamic, where co-administered agents exert additive or synergistic effects on neuronal excitability. A clear understanding of mechanisms of action—ranging from voltage-gated sodium-channel blockade to enhancement of inhibitory GABAergic transmission—is essential for optimising combinations and avoiding antagonistic pairings. Therapeutic drug monitoring can guide dose adjustments to maintain effective plasma concentrations and minimise toxicity. Emerging research also explores natural compounds as adjuncts to classical ASMs, highlighting the potential for botanical derivatives to modulate both pharmacokinetic and pharmacodynamic parameters. Personalized medicine models are increasingly applied to predict interaction profiles and support clinical decision-making. Overall, balancing efficacy, tolerability and interaction risk is critical to improving seizure freedom rates and patients’ quality of life on a global scale.
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Antiepileptic Drug Therapy and Pharmacological Interactions publication trend
The graph below shows the total number of articles in antiepileptic drug therapy and pharmacological interactions across all publications each year (not limited to Nature Index journals).
Technical terms
Antiseizure medication (ASM): A drug prescribed to prevent or reduce the frequency of epileptic seizures.
Pharmacokinetic interaction: An effect whereby one drug alters the absorption, distribution, metabolism or excretion of another.
Pharmacodynamic interaction: A combined effect of two or more drugs at their sites of action, which can be synergistic, additive or antagonistic.
Synergistic interaction: A drug combination producing a greater effect than the sum of individual effects.
Drug-resistant epilepsy: Failure to achieve seizure control after two adequately chosen and tolerated ASM trials.
References
- Antiseizure Effects of Scoparone, Borneol and Their Impact on the Anticonvulsant Potency of Four Classic Antiseizure Medications in the Mouse MES Model—An Isobolographic Transformation. International Journal of Molecular Sciences (2023).
- The pharmacological treatment of epilepsy in adults. Epileptic Disorders (2023).
- Influence of Umbelliferone on the Anticonvulsant and Neuroprotective Activity of Selected Antiepileptic Drugs: An In Vivo and In Vitro Study. International Journal of Molecular Sciences (2022).
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