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Antiepileptic Drugs for MS Symptoms: How Are They Used?

Posted on May 18, 2022
Medically reviewed by
Joseph V. Campellone, M.D.
Article written by
Simi Burn, PharmD

Multiple sclerosis (MS) can result in a wide variety of symptoms. In some people, that may include epileptic seizures, resulting from brain lesions affecting individuals with MS. Although seizures can be scary, there are ways to treat them — including using antiepileptic drugs (AEDs) A doctor also may prescribe AEDs for other types of MS symptoms, including spasticity (muscle stiffness), nerve pain, and the MS hug.

MS and Seizures

MS can cause brain lesions and plaques, which can lead to seizures. In addition, chronic inflammation resulting from multiple sclerosis can lead to scarring in areas of the brain. This can disrupt the connections between neurons in the central nervous system, potentially leading to seizures.

Epilepsy — characterized by recurring seizures — is slightly more common among people living with MS than in the general population. In the United States, just over 1 percent of people have epilepsy, while an estimated 2 percent to 5 percent of people with MS have epilepsy.

MyMSTeam members have shared their experiences with seizures. “I’m not remembering anything because of the seizures, and it’s very frustrating,” shared one member. Another wrote, “I had seizures. I am on levetiracetam. It’s not easy after 15 seizures in a row.” Another member shared, “Another day with three grand mal seizures in one day.”

There are two major classes of seizures: generalized and focal. Generalized seizures involve both halves of the brain. Focal seizures, also known as partial seizures, affect one area of the brain.

Seizure symptoms can vary, depending on which part of the brain triggers the seizures. For example, a person having a seizure may appear confused or seem to be staring off into space. Other types of seizures can cause a person to jerk uncontrollably, topple over, or lose awareness of what’s happening around them. Seizures also can cause a change in sensation, such as a strange taste or smell.

Researchers do not yet know if MS-related seizures are connected specifically to MS relapses, or if they’re also likely to occur at other times. Some evidence indicates that seizures may be the first symptom of MS, even before an MS diagnosis is made.

Which AEDs Are Used To Treat Seizures in MS?

Antiepileptic drugs are often used to treat MS-related seizures. Your doctor will prescribe an AED treatment for seizures based on individual factors, including a person’s age, sex, comorbidities (secondary conditions), and what medications they’re taking. No single AED has proven to be better than others in general for treating seizures in MS. There are older and newer AEDs that are used to treat MS-related seizures.

Older AEDs include:

  • Carbamazepine (sold as Tegretol and Carbatrol)
  • Divalproex sodium (Depakote)
  • Phenobarbital
  • Phenytoin (sold as Dilantin and Phenytek)
  • Primidone (Mysoline)
  • Valproic acid (Depakene)

Newer AEDs include:

  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Levetiracetam (Keppra)
  • Oxcarbazepine (Trileptal)
  • Pregabalin (Lyrica)
  • Tiagabine (Gabitril)
  • Topiramate (Topamax)
  • Zonisamide (Zonegran)

Generally, a goal in treatment is to choose one AED that can stand alone as a single therapy for seizures, because that limits the potential for adverse effects and drug interactions.

Which Other MS Symptoms Do AEDs Treat?

As less than 5 percent of people with MS have epilepsy or seizures, doctors more often prescribe AEDs to help treat MS symptoms other than seizures.

Among them, AEDs such as gabapentin, clonazepam, or others can help with spasticity. Carbamazepine and gabapentin are sometimes prescribed for MS-related nerve pain. Gabapentin and pregabalin may be helpful in treating the MS hug.

Do AEDs for MS Symptoms Have Side Effects?

All AEDs have the potential to cause side effects depending on the person and the dose. Side effects are the most common reason people stop using a particular AED, so your physician’s drug choice may depend on which one you can best tolerate. Side effects are more common if someone is taking more than one AED.

Usually, side effects with AEDs are more noticeable when the drug is taken for the first time or when the dosage is increased. In general, doctors will introduce a new AED slowly at a low dose, then gradually increase the dose over days or weeks to give a person’s body time to adjust. That way, both they and their doctor can monitor whether the AED is working to make sure side effects are minimized as much as possible.

Because the risk of side effects rises with higher doses of AEDs, sometimes your doctor will cut down your dose to reduce side effects, or they may change you to another AED. Never stop taking a medication (or start a new one) without consulting your neurologist first.

Common Side Effects of AEDs

The most common side effects of AEDs are:

  • Blurred vision
  • Dizziness
  • Drowsiness
  • Fatigue
  • Lack of coordination

Rare Side Effects of AEDs

All of the older AEDs and several of the newer AEDs can cause rare side effects, which usually require your doctor to discontinue the medication. Some examples of rare side effects of AEDs include:

Reproductive Side Effects of AEDs

Some MyMSTeam members have questioned whether AEDs may lead to reproductive side effects. “Does gabapentin affect female fertility?” one member asked.

Studies indicate that AED reproductive side effects can occur when taking older antiepileptic drugs, which may affect fertility, sexual function, and reproduction:

  • In females, AEDs can cause reduced fertility, hormone dysfunction, polycystic ovary syndrome, and menstrual disorders.
  • In males, AEDs can cause reduced fertility, hormone dysfunction, sperm abnormalities, erectile dysfunction, and reduced testicular volume.

The newer AEDs seem to cause fewer reproductive side effects, but more clinical trials are needed in order for researchers to know more. If you’re thinking about getting pregnant soon or in the future, talk to your neurologist to ensure your medications don’t disrupt your chances of conceiving.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 185,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with multiple sclerosis and seizures? Have you taken AEDs for MS symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Seizures and Multiple Sclerosis — Epilepsy Foundation
  2. Types of Seizures — Centers for Disease Control and Prevention
  3. Epilepsy and Multiple Sclerosis — Epilepsy & Behavior
  4. Seizures in Patients With Multiple Sclerosis: Epidemiology, Pathophysiology, and Management — CNS Drugs
  5. Minimizing AED Adverse Effects: Improving Quality of Life in the Interictal State in Epilepsy Care — Current Neuropharmacology
  6. Gabapentin for Relief of Spasticity Associated With Multiple Sclerosis — American Journal of Physical Medicine & Rehabilitation
  7. Clonazepam, Baclofen and Placebo in the Treatment of Spasticity — European Neurology
  8. Multiple Sclerosis Induced Neuropathic Pain: Pharmacological Management and Pathophysiological Insights From Rodent EAE Models — Inflammopharmacology
  9. Treatment of Epilepsy in Multiple Sclerosis — Seizure
  10. AED Side Effects and Interactions — Epilepsy Foundation
  11. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis — Genetic and Rare Diseases Information Center
  12. Antiepileptics and Blood Dyscrasias: A Cohort Study — Pharmacotherapy
  13. Hepatotoxicity Associated With Antiepileptic Drugs — Acta Neurologica Scandinavica
  14. Teratogenicity of Antiepileptic Drugs — Clinical Psychopharmacology and Neuroscience
  15. Impact of Antiepileptic Drugs on Bone Health: Need for Monitoring, Treatment, and Prevention Strategies — Journal of Family Medicine and Primary Care
  16. Osteoporosis and Epilepsy — Epilepsy Society
  17. Drug-Induced Peripheral Neuropathy: A Narrative Review — Current Clinical Pharmacology
  18. Reproductive Health in Patients With Epilepsy — Epilepsy & Behavior
  19. Antiepileptic Drugs Influences on Body Weight in People With Epilepsy — Expert Review of Clinical Pharmacology
  20. The Effects of Antiepileptic Drugs on Oral Health — Journal of the Canadian Dental Association
  21. Effect of Antiepileptic Drugs on Reproductive Endocrine Function in Individuals With Epilepsy — CNS Drugs
  22. PCOS (Polycystic Ovary Syndrome) and Diabetes — Centers for Disease Control and Prevention

All updates must be accompanied by text or a picture.
Joseph V. Campellone, M.D. is board-certified in neurology, neuromuscular disease, and electrodiagnostic medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Simi Burn, PharmD is a seasoned pharmacist with experience in long-term care, geriatrics, community pharmacy, management, herbal medicine, and holistic health.. Learn more about her here.

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