Emergent Complications of the Newer Anticonvulsants

Background: Multiple new anticonvulsants have been introduced recently and they are supplanting the older medications. Whereas the older drugs have well-recognized side effects, both in typical therapeutic doses and in overdosage, the properties of the newer ones are unique and largely unknown to all but sub-specialists. Objectives: This article gives a concise overview of the potential complications of these new medications in both therapeutic use and overdose. Discussion: Clinically significant side effects of the new anticonvulsants, such as metabolic acidosis from topiramate, autoimmune reactions from lamotrigine, hyponatremia from oxcarbazepine, or psychosis from levitiracetam can cause serious morbidity and mortality if unrecognized. The effects of these medications in overdose are also largely unknown to most emergency physicians. Conclusions: This article reviews the major potential side effects of the new seizure medications and the treatment of their overdoses for the practicing emergency physician.