Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected

Drug-induced liver injury remains a major concern in the pharmacological management of epilepsy. Antiseizure medication (ASM)-related liver injury has multiple phenotypes, and in the majority of cases it is "idiosyncratic," involving hypersensitivity reactions. Awareness of drug- and patient-related risk factors can help direct treatment selection, monitoring, and ASM discontinuation, when necessary. This article examines the typical patterns of ASM-induced liver injury, from mild elevations of hepatic enzymes to life-threatening conditions. We also discuss risk factors, means for preventing liver injury in people with epilepsy treated with ASMs, and emerging biomarkers.