⌁ NeurologicSeizures, Parkinson's, migraines, dementia, and nerve pain — drugs that turn brain signals up or down.
See integrative options for this system →
Antiepileptics 12 drugs Calm over-firing brain circuits — each drug damps a different channel or neurotransmitter.
Treats: Epilepsy/seizures · Status epilepticus · Bipolar disorder (valproate, lamotrigine) · Neuropathic pain (several)
Never stop abruptly — withdrawal seizures; lamotrigine and carbamazepine can cause Stevens-Johnson syndrome; valproate boxed warnings — liver failure, pancreatitis, birth defects; most carry suicidality warnings. levetiracetam, phenytoin, fosphenytoin, valproate, carbamazepine…
Parkinson's Disease Agents 10 drugs Refill or mimic the brain's missing dopamine so movement flows again.
Treats: Parkinson disease · Restless legs syndrome (dopamine agonists) · Drug-induced parkinsonism (amantadine, benztropine)
Never stop levodopa abruptly — a parkinsonism-hyperpyrexia state resembling NMS; dopamine agonists cause impulse-control disorders (gambling, hypersexuality) and sleep attacks; hallucinations. carbidopa-levodopa, pramipexole, ropinirole, rotigotine, selegiline…
Triptans (Acute Migraine) 5 drugs Abort a migraine in progress by constricting dilated brain vessels and quieting pain nerves (serotonin 1B/1D agonists).
Treats: Acute migraine · Cluster headache (sumatriptan injection)
Contraindicated in coronary artery disease, uncontrolled hypertension, and prior stroke — they constrict coronary arteries too; serotonin syndrome when stacked with SSRIs/SNRIs. sumatriptan, rizatriptan, eletriptan, zolmitriptan, naratriptan
Migraine Preventives (CGRP era) 7 drugs Reduce how often migraines happen — from repurposed blood pressure and seizure drugs to the new CGRP antibodies.
Treats: Chronic/frequent migraine prevention
Topiramate causes word-finding problems, kidney stones, and is teratogenic; propranolol contraindicated in asthma; CGRP agents can cause constipation and hypertension (erenumab). erenumab, fremanezumab, galcanezumab, rimegepant, ubrogepant…
Alzheimer's / Dementia Agents 5 drugs Boost acetylcholine or block excess glutamate to slow symptom decline — they do not stop the disease.
Treats: Alzheimer disease · Other dementias (off-label)
Cholinesterase inhibitors cause bradycardia, syncope, and GI upset — dangerous with beta blockers; set realistic family expectations: modest benefit. donepezil, rivastigmine, galantamine, memantine, lecanemab
Multiple Sclerosis Agents 7 drugs Redirect or suppress the immune attack on nerve insulation (myelin).
Treats: Relapsing MS · Acute MS flare (high-dose steroids)
Natalizumab boxed warning: PML (fatal brain infection) — JC virus testing required; fingolimod causes first-dose bradycardia and macular edema; most are immunosuppressive. interferon beta-1a, glatiramer, fingolimod, dimethyl fumarate, teriflunomide…
Neuropathic Pain Agents (Gabapentinoids & Friends) 5 drugs Quiet damaged, misfiring pain nerves — burning, shooting, electric pain that opioids treat poorly.
Treats: Diabetic neuropathy · Postherpetic neuralgia · Fibromyalgia · Seizures (adjunct)
Sedation, dizziness, and falls; respiratory depression when combined with opioids; renal dosing required; abrupt stop can trigger withdrawal/seizures; misuse potential (pregabalin is C-V). gabapentin, pregabalin, duloxetine, capsaicin (topical), lidocaine patch
