South Middlesex Times

Molecular tests and other screening tools can mitigate the risk of potentially fatal reactions to antiseizure medications, which are used by millions of Americans for epilepsy and other conditions. However, skin rashes still necessitate immediate medical attention, according to research from Rutgers Health.

Rashes are a prevalent side effect of antiseizure medications, appearing in 2 percent to 16 percent of patients, depending on which of the 26 Food and Drug Administration (FDA)-approved medications they use. Although most rashes are not serious, approximately 5 percent indicate life-threatening reactions. The FDA recently issued a warning about severe reactions to two antiseizure medications: levetiracetam and clobazam.

"Dangerous reactions are rare, but patients and caregivers should still understand the risk and how to respond if things happen," said Ram Mani, chief of the adult epilepsy division at Rutgers Robert Wood Johnson Medical School and lead author of the study published in Current Treatment Options in Neurology.

"Patients should seek medical treatment if rashes develop rather than waiting for them to disappear," Mani advised. "If symptoms are mild, they can contact their neurologist or primary care physician, but serious symptoms like a high fever warrant a trip to the emergency room or a 911 call."

The appropriate antiseizure medication can eliminate epilepsy symptoms in 70 percent of patients and alleviate them in most others. These medications also assist many patients with bipolar disorder, anxiety, migraines, and neuropathic pain.

The new study collates published data on individual antiseizure medication, differentiates the various rashes such medications can trigger, and elucidates how to treat each one.

Factors that heighten the risk of severe reactions include using aromatic antiseizure medications, rapid dose escalation, genetic predisposition to reaction, simultaneous use of other medicines that affect drug metabolism. Women under age 50 and boys under 10 also experience more frequent reactions, as do people with diseases such as HIV or lupus or those undergoing treatments like radiation therapy that alter immune activity.

"Patients who react to one medication are more likely to react to others, particularly others in the same drug class, but with 26 FDA-approved options, we can typically find each patient an effective treatment with minimal side effects," Mani said.

Antiseizure medications can trigger at least 10 distinct rash types. Reactions such as a fixed drug eruption — characterized by a small number of bumps — can begin within hours of the first injection, while other skin rashes, such as lichenoid drug reactions, can occur after the patient has been using a medication for years.

The most common reaction is called morbilliform exanthematous eruptions. These typically occur in the first two weeks of treatment onset and cover the torso (and often the limbs) with small bumps. Symptoms usually disappear without treatment a few weeks after patients discontinue whatever medication provokes them but can worsen for several days before they start improving.

Severe conditions often require urgent treatment. The reaction known as Stevens-Johnson syndrome or toxic epidermal necrolysis — which produces fever, eye pain and detached skin — typically requires that victims receive inpatient care at a hospital burn unit.

Mani estimated that several thousand patients suffer severe reactions to antiseizure medications each year but added that numbers could decrease significantly if neurologists consistently put high-risk patients on low-risk medicines.

"I gave a talk on this topic at the American Epilepsy Society Conference last year, and I asked the 200 or so doctors in the room how frequently they perform the recommended [genetic] tests on patients of South Asian ancestry [the only group prone to the relevant genes] and only a handful raised their hands," Rami said. "So there’s definitely room for improvement to increase patient safety."