This is a question I hear often from Persons With Epilepsy (PWEs): “Do older anti-seizure drugs (ASDs) have worse side effects than the newer ones?” Unfortunately, the answer is usually yes.
Older generation ASDs tend to come with harsher and more pronounced side effects. For example, drugs like phenytoin can cause gum overgrowth (gingival hyperplasia) and liver problems if used for long periods. Valproate is associated with several complications, including weight gain, tremors, and potential risks during pregnancy. Carbamazepine—another commonly used older drug—has its own set of side effects, such as dizziness, low sodium levels, and potential liver issues.
Does this mean newer medications are completely free from side effects? Not at all. Modern ASDs like levetiracetam (Keppra) and lamotrigine still have side effects, but medical science has made significant progress in reducing their severity while maintaining strong seizure-control effectiveness. Many newer drugs are also better tolerated and easier to combine with other medications, which is a huge benefit for people who need multi-drug therapy.
However, this doesn’t mean older ASDs should automatically be abandoned in favor of newer ones. In fact, many older drugs are still extremely effective. I’m a good example of this: I’ve been seizure-free for over five years while taking carbamazepine, an older generation drug. For me, the benefits have outweighed the manageable side effects. This is a reminder that each person’s response to medication is unique.
At Seizure Support, our advice is simple and practical. Always consult your doctor to determine which medication works best for your specific type of epilepsy, seizure pattern, and lifestyle. The right choice balances effectiveness and manageable side effects—and that balance looks different for everyone. If a newer drug works well with fewer side effects, that’s great. If an older drug keeps seizures under control reliably, that’s also a valid option.
We also encourage PWEs to visit our Patient Portal, where they can interact with volunteer doctors and receive guidance about their medication options and overall epilepsy management. The more informed you are, the more confident you can be in making decisions about your health.
This issue is discussed in detail in the Epilepsy Management Guide, which you can download for free. To participate in the discussion on this topic, visit the Global Epilepsy Forum. To know more about what we do, please click HERE. We also have a donation page where those who feel compelled can give whatever they can afford by clicking HERE.
