NEWER ANTIEPILEPTIC DRUGS
Wallace SJ
University Hospital of Wales, Cardiff,
UK
Objective: An update on the places of gabapentin, lamotrigine, topiramate,
tiagabine, oxcarbazepine, vigabatrin, stiripentol, felbamate and
levetiracetam in the treatment of childhood epilepsy is to be presented.
Methods:
The literature has been reviewed. Additional personal studies are added.
Particular emphasis is given to potentially resistant seizures.
Results:
Gabapentin is useful for partial seizures: it has a low adverse event
profile. Lamotrigine has a
wide spectrum of efficacy, which includes the Lennox-Gastaut syndrome. Dose
introduction must be very slow, especially if it is added to valproate. Topiramate is effective for partial
seizures. It can be useful, in
combination with lamotrigine, for atonic seizures; and, could be helpful in
resistant West syndrome.
Tiagabine can control otherwise resistant partial seizures, but its
role in other seizures in young children is still unclear. Oxcarbazepine
has a place as first-choice therapy for partial seizures. Because of the
potential for visual field defects, the use of vigabatrin should be
restricted to partial seizures resistant to other drugs and to West
syndrome. Stiripentol can be effective for severe myoclonic epilepsy in
infancy. Felbamate has proven efficacy for the Lennox-Gastaut syndrome and
partial seizures, but its use is limited by the risk of hepatic and blood
disorders. Levetiracetam controls partial seizures: it shows promise for
other epilepsies.
Conclusions: There is a wide
range of drugs available for childhood epilepsy. Maximal benefit will be
achieved if the appropriate drug is chosen for specific seizure types and
epilepsies.