Many people with epilepsy rely on antiseizure medications (ASMs), also known as antiepileptic drugs (AEDs), to manage their condition. However, these medications can sometimes have side effects, including changes in weight. While some ASMs may lead to weight gain, others can cause weight loss, and some may have no effect on weight at all. It's essential to discuss your concerns about weight changes and other side effects with your healthcare professional to find the most effective treatment plan for you.
How Seizure Medications Affect Weight
Seizure medications can affect weight in various ways. Some may slow down your metabolism, causing you to burn fewer calories. Others may change your brain's chemistry, disrupting the signals that tell you when you're hungry. This disruption can lead to increased hunger and, consequently, weight gain. Conversely, some medications may suppress hunger, potentially leading to weight loss.
ASMs Associated with Weight Gain
Several ASMs have been linked to weight gain in some individuals. These include:
- Valproate (valproic acid)
- Carbamazepine
- Gabapentin
- Pregabalin
- Divalproex
- Vigabatrin
Valproate, in particular, is known for its potential to cause weight gain as a side effect. Research has shown that individuals taking valproate may experience significantly higher body weight compared to those taking other ASMs like lamotrigine. Studies indicate that valproate and carbamazepine may cause weight gain in 71% and 43% of people who take them, respectively.
A study of children under 12 years old taking valproate or carbamazepine monotherapy found that only the children taking carbamazepine gained weight. Experts suggest that valproate-associated weight gain is more commonly observed in postpubertal teens and adults, with weight loss sometimes seen in very young children on valproate.
Read also: Weight Loss Meds & BCBS
ASMs Associated with Weight Loss
A few ASMs have the potential to cause weight loss in some individuals. These include:
- Topiramate
- Zonisamide
- Felbamate
Topiramate, sold under the brand name Topamax, is an anticonvulsant medication prescribed to treat seizures and epilepsy. It is also used for migraine prevention. Topiramate has been shown to cause weight loss in some patients. While its exact mechanism of action is not fully understood, possible mechanisms include appetite suppression, preventing the body from storing excess fat, and lowering some fat and cholesterol levels. It might also affect the brain's reward system, potentially preventing binge eating. Topiramate may influence a hormone called leptin, which plays a role in fat storage. Some studies have found that topiramate can lower leptin levels, which may contribute to weight loss. Additionally, topiramate may affect genes related to neuropeptide Y, which can influence the body's weight regulation system. Moreover, topiramate may work by blocking a substance called carbonic anhydrase that affects how the body metabolizes sugar and lipids (fat cells).
Weight loss was reported in studies of both children and adults taking topiramate. Side effects were assessed in patients 16 years and older taking topiramate (Topamax) alone (without other seizure medicines) at two doses: 50 mg / day or 400 mg / day. In the patients taking the lower 50 mg / day dose of topiramate, weight loss occurred in 6% of patients, and in the higher 200 mg/day dose, weight loss was reported in 17% of patients. When topiramate (Topamax) was studied in adults who used it in addition to other medicines (adjunctive treatment) for seizure control, weight loss occurred in 9% of patients receiving 200 mg / day to 400 mg / day, and 3% of those taking a placebo (an inactive pill). In adults using doses of 50 mg / day for migraine prevention, 6% of patients experienced weight loss, while in the 100 mg / day group, 9% of patients reported weight loss. In contrast, 1% of patients in the placebo group lost weight. In children 6 to 15 years of age taking the 50 mg / day dose of topiramate (Topamax) for seizures, weight loss was seen in 7% of patients. In the higher dosage group (400 mg / day) weight loss occurred in 17% of children. In adolescents 12 to 17 years of age, weight loss occurred in 7% (50 mg / day dose) and 4% (100 mg / day) compared to 2% in the placebo group.
Weight-Neutral ASMs
Some ASMs are considered weight-neutral, meaning they are not typically associated with weight changes. These include:
- Lamotrigine
- Levetiracetam
- Phenytoin
- Oxcarbazepine
- Eslicarbazepine
- Lacosamide
- Carbamazepine
- Vigabatrin
- Clobazam
Levetiracetam (Keppra) is generally considered "weight-neutral," but some people taking it for epilepsy treatment may notice weight changes. In one study, a small percentage of people taking levetiracetam experienced a weight change, but it wasn’t very different from the group of people taking the placebo. Researchers concluded that levetiracetam was weight-neutral. Weight loss isn’t a common side effect of levetiracetam, but one small study focused on 19 cases of people whose weight loss was or might have been related to the treatment. Side effects like nausea and vomiting or depression may also contribute to weight loss while taking levetiracetam. If levetiracetam causes weight changes, it’s more often associated with weight loss, not weight gain. In one small study, two of the 60 participants gained between six and 11 pounds after taking levetiracetam for three months. If you experience depression or mood changes as a side effect of levetiracetam, you may notice more food cravings that cause you to eat more and gain weight.
Read also: A guide to Mercy Care and weight loss medications.
It's important to remember that everyone responds to treatment differently. Even if a medication is considered weight-neutral, it may not be weight-neutral for everyone.
The Role of Dosage
Dosage is an important factor to consider, as it is typically related to the degree of side effects. Your doctor may need to adjust your dosage or change your medication depending on how you respond to the ASM.
Managing Weight While Taking Seizure Medication
Besides keeping track of any side effects you experience, you can take several steps to manage your weight while taking seizure medication:
- Eat a balanced diet: Focus on fruits, vegetables, and whole foods. A low-glycemic index diet, emphasizing complex carbohydrates over simple sugars, may be beneficial.
- Exercise regularly: Aim for at least 150 minutes of exercise per week, or as you are able. Be mindful of seizure-related limitations and consider a buddy system for safety.
- Get enough sleep: Aim for 7 to 9 hours of sleep nightly.
- Manage stress: Find healthy ways to manage stress in your life.
- Consider weight loss drugs: Speak with your doctor about weight loss drugs if necessary.
Obesity and Epilepsy
Obesity is a risk factor for epilepsy. Excess adiposity increases the secretion of inflammatory markers, which can inflame neural circuits and initiate or lead to the progression of epilepsy.
Alternatives to Topiramate
Topiramate is one of many prescription drugs currently being used for weight management. However, topiramate is FDA-approved to treat seizures and epilepsy, primarily. It is most effective for weight loss at higher doses, which can increase the risk of adverse side effects. If you are looking for an alternative to topiramate, talk to your doctor about:
Read also: Does BCBS Cover Weight Loss?
- Semaglutide (available as Ozempic, Wegovy, or Rybelsus)
- Tirzepatide (available as Mounjaro or Zepbound)
- Liraglutide (available as Saxenda)
- Naltrexone/ Bupropion (available as Contrave)
- Metformin
- Qsymia (topiramate/ phentermine)
Qsymia contains the active compound in Topamax-topiramate-combined with phentermine, an appetite suppressant. Unlike Topamax, Qsymia is an FDA-approved weight management medication.
Consulting Your Doctor
It is essential to speak with your doctor about potential side effects, including weight changes, from seizure medications. They can help you find the most effective treatment plan while minimizing unwanted side effects.
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