Cutaneous Adverse Drug Reactions to Antiseizure Medications

Abstract

Discontinuation of antiseizure medications (ASMs), primarily prompted by adverse effects, presents a formidable challenge in the management of epilepsy, and impacting up to 25% of patients. This article thoroughly explores the clinical spectrum of cutaneous adverse drug reactions (cADRs) associated with commonly prescribed ASMs. Ranging from mild maculopapular rashes to life-threatening conditions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the diverse manifestations are meticulously detailed. Diagnostic strategies, incorporating red flags and testing methodologies, are elucidated to ensure precise identification. The classification of adverse drug reactions (ADRs), with a specific focus on cADRs and their association with type A or type B reactions, is presented. Critical risk factors, encompassing patient demographics, drug-related skin reactions, and genetic predispositions, are thoroughly explored. The article underscores the role of human leucocyte antigen (HLA), including HLA*15:02, in predicting susceptibility to severe reactions like SJS/TEN, particularly with aromatic ASMs prevalent in specific populations. Management strategies for varying cADR severities are discussed, placing emphasis on drug discontinuation, symptomatic relief, and potential desensitization. The article concludes by consolidating current knowledge, providing clinicians with a roadmap for navigating the complexities of diagnosis and management. The integration of personalized medicine principles and evidence-based approaches emerges as a crucial paradigm for the future of epilepsy management, aiming to minimize the impact of ADRs on patient outcomes.

Keywords: Anticonvulsants, Epilepsy/drug therapy; HLA antigens/genetics; Skin diseases/drug therapy; Stevens-Johnson syndrome; Toxic epidermal necrolysis.