PLACE OF NEWER ANTIEPILEPTIC DRUGS IN THE TREATMENT OF EPILEPSY

There are several new antiepileptic drugs undergoing extensive clinica l investigation. Five new drugs - vigabatrin, lamotrigine, gabapentin, felbamate and oxcarbazepine - appear to be the most widely tested and promising agents. Vigabatrin is most effective in drug-resistant part ial epilepsy. Vigabatrin is also effective in infantile spasms, but se ems to have negative effects on myoclonic epilepsies and absence seizu res. Lamotrigine and felbamate seem to be effective in partial epileps y and in Lennox-Gastaut syndrome. In addition, lamotrigine and felbama te seem to have efficacy in idiopathic generalised epilepsies. Oxcarba zepine appears to be equally as effective as carbamazepine, but less t oxic. Gabapentin has few adverse effects and has efficacy in some pati ents with drug-resistant partial epilepsy. Some of the new antiepilept ic drugs modify excitatory or inhibitory amino acid transmission, but some of them may employ new, still unknown mechanisms of action. Depen ding on the mechanism of action, the therapeutic effectiveness of the antiepileptic drugs may differ in specific epileptic syndromes. Future antiepileptic drugs may thus give us the possibility to design ration al polypharmacy for individual patients by combining agents with diffe rent spectra of effectiveness. Considering the goal of good tolerabili ty in the development bf the new antiepileptic drugs, polypharmacy wit h these agents is not expected to increase adverse effects significant ly.