Table 5.
Main drugs used to treat DEEs and target pathways/molecules
| Excitatory Transmission | Na+ Channels | Ca2+ Channels | K+ Channels | Glutamate Receptors | 5-HT Receptors | Sigma-1 Receptors | Inhibitory Transmission | GABA-A Receptors | GABA Turnover | GABA-B Receptors | SV2A Binding | Carbonic Anhydrase | Clinical Efficacy | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Barbiturates | YES | YES | BS | |||||||||||
| Benzodiazepines | YES | YES | BS | |||||||||||
| Brivaracetam | YES | FS | ||||||||||||
| Cannabidiol | YES | LGS, DS | ||||||||||||
| Carbamazepine | YES | YES | YES | FS, GTCS | ||||||||||
| Cenobamate | YES | YES | YES | FS (adult) | ||||||||||
| Clobazam | YES | YES | YES | LGS, FS | ||||||||||
| Eslicarbazepine | YES | YES | FS | |||||||||||
| Ethosuximide | YES | YES | ABS | |||||||||||
| Felbamate | YES | YES | YES | YES | YES | YES | BS | |||||||
| Fenfluramine | YES | YES | YES | DS | ||||||||||
| Gabapentin | YES | YES | YES | YES | YES | FS, GTCS | ||||||||
| Lacosamide | YES | YES | YES | FS, SGS | ||||||||||
| Lamotrigine | YES | YES | YES | FS, GCTs, ABS | ||||||||||
| Levetiracetam | YES | YES | YES | YES | YES | YES | BS | |||||||
| Oxcarbazepine | YES | YES | YES | YES | FS, GTCS | |||||||||
| Perampanel | YES | YES | FS, GTCS | |||||||||||
| Phenobarbital | YES | YES | YES | YES | YES | FS | ||||||||
| Phenytoin | YES | YES | YES | FS, GTCS | ||||||||||
| Pregabalin | YES | YES | YES | FS | ||||||||||
| Primidone | YES | YES | YES | YES | FS, GTCS | |||||||||
| Retigabine | YES | YES | FS | |||||||||||
| Rufinamide | YES | YES | LGS | |||||||||||
| Stiripentol | YES | YES | DS | |||||||||||
| Tiagabine | YES | YES | FS | |||||||||||
| Topiramate | YES | YES | YES | YES | YES | YES | YES | YES | BS | |||||
| Valproate | YES | YES | YES | YES | YES | YES | BS | |||||||
| Vigabatrin | YES | YES | FS, ES | |||||||||||
| Zonisamide | YES | YES | YES | YES | FS, GTCs, MYO |
ABS, absence; BS, broad spectrum; DEE, developmental and epileptic encephalopathy; DS, Dravet syndrome; ES: epileptic spasms; FS, focal seizures; GABA, γ-aminobutyric acid; GTCS, generalized tonic-clonic seizures; 5-HT, 5-hydroxytryptamine; LGS, Lennox–Gastaut syndrome; MYO: myoclonic, SGS: secondary generalized seizures; SV2A, synaptic vesicle protein 2. Adapted from https://www.uptodate.com/contents/antiseizure-drugs-mechanism-of-action-pharmacology-and-adverse-effects.