DISSCUSION
Epilepsy is a relatively common condition characterized by a tendency for recurrent seizures, which is due to the disturbance of spread of electrical discharge of the cortical neurons.19Epilepsy is either: idiopathic when there is no underlying cause or secondary if there is an underlying cause egg brain tumors, stroke. Clinically seizures are divided into two basic categories, generalized and focal. As many as 80% of epilepsy patients can be controlled with anti-epileptic drugs. The type of medication prescribed depends on the type of seizure, the underlying cause of the epilepsy, the age of the patient, possible side effects, and the availability of the medication. Treatment usually starts with a low dose and then gradually increases. In most patients, the epilepsy will subside after a few years and medications can be stopped gradually.
Phenytoin is effective for the treatment of focal and tonic clonic seizures.Carbamazepine is effective in the treatment of focal and generalized tonic-clonic seizures, while phenobarbital is as effective as phenytoin and carbamazepine in clearing focal and generalized tonic-clonic seizures. On the other hand, sodium valproate is effective for all types of epilepsy patients. The occurrence of adverse effects unrelated to the dose, is particularly prominent during the initiation of therapy (especially with carbamazepine and valproic acid), but disappear as tolerance develops. For this reason, therapy with these drugs should be started on low doses and the dose slowly titrated up to the recommended maintenance over several weeks. 20
Cosmetic effects of AEDs are of particular concern among women because they can damage body image and self-esteem.  Adverse effects of antiepileptic drugs (AEDs) are common, can have a considerable impact on quality of life and contribute to treatment failure in up to 40% of patients. Women are more likely to experience Cosmetic side effects (CSEs) compared with men. Like what was reported by other researchers’ worldwide cosmetic side effects (CSEs) such as weight gain and alopecia are common among our studied group and occurred commonly among patients taking sodium valproate.21 Current guidelines recommend valproate (VPA) as a treatment of first choice for patients with generalized onset seizures. Weight gain is a known dose-related side effect of valproic acid that more commonly is seen in women. Polycystic ovary disease and hyperandrogenism are common in women taking valproate. Hyperandrogenism presents as hirsutism, acne, or male-pattern alopecia. Other AEDs, such as felbamate and topiramate, are associated with significant weight loss, occasionally requiring discontinuation of the AEDs.Like what was mentioned in the literature phenytoin causes excessive hair growth, particularly on the face and arms, as well as facial acne and coarsening.21Gingival hypertrophy was reported in 13% of persons taking phenytoin.
Like what was mentioned in the literature maculopapular rashes were noted in 3% of our patients started on carbamazepine, phenytoin, phenobarbital, and lamotrigine.22Rarely severe mucocutaneous reactions such as Stevens-Johnson syndrome, and toxic epidermal necrolysis can occurred with the use of these antiepileptic drugs. 23Patient taking phenobarbital can have many skin reactions, including: morbilliform, urticaria, erythema multiforme, photosensitivity, acneiform rash, and purpura. Skin eruptions are significantly more likely if lamotrigine is given with valporic acid, especially if the recommended dose is exceeded.Adverse effects of Lamotrigine may include serious toxic epidermal necrolysis, in which alopecia is a well-known phenomenon. The occurrence of carbamazepine-induced alopecia is at or below 2%.24Hair loss is a side effect of patients taking aromatic anticonvulsants, but it rarely occurs after such drugs are discontinued during recovery from anticonvulsant hypersensitivity syndrome. 24
Epilepsy has diverse effects on the overall wellbeing or subjective quality of life (QOL) of the patients.25 QOL in epilepsy is associated with several factors. These factors include clinical variables (for example, seizure frequency, severity, illness duration, treatment side effects and psychiatric co- morbidities), social disadvantages (for example, divorce, unemployment, social stigma, and illness intrusion into social life), and family circumstances (such as family caregiver characteristics and social support).25Adverse effects of antiepileptic drugs have emerged as one of the strongest predictors of impaired health-related quality of life, independent of seizure outcome. 26