2022 年 39 巻 4 号 p. 650-653
Since 2006, many newer antiseizure medications (ASMs) have been launched in Japan. When using newer ASMs, it is recommended to consider their efficacy, side effects, and added values for providing personalized treatment. Recent studies on patients with focal epilepsy suggested that the efficacy of several newer ASMs is not inferior to that of carbamazepine, an established first–line drug. Newer ASMs have less drug–drug interaction and long–term adverse reactions such as osteoporosis and cardiovascular events than older ones. Among newer ASMs, zonisamide and lamotrigine exhibit a higher incidence of severe rash than others. Zonisamide and topiramate decrease cognitive functions. Psychiatric side effects are observed in zonisamide, topiramate, levetiracetam, and perampanel users. Added values include the anti–migraine effect of topiramate, anti–depression effect of lamotrigine, anti–anxiety effect of gabapentin, the long half–life of perampanel, and less drug–drug interaction of gabapentin, levetiracetam, and lacosamide. Various mechanisms of action of newer ASMs help more rational polytherapy. Comorbidities such as depression, migraine, dementia, and cardiovascular diseases are vital factors to optimize medication. Lamotrigine and levetiracetam are favorable for women of childbearing age because of their low teratogenicity. During pregnancy, the blood level of lamotrigine and levetiracetam should be monitored to keep optimal levels and avoid seizure worsening.
