NEW ANTIEPILEPTIC DRUGS - OVERCOMING THE LIMITATIONS OF TRADITIONAL THERAPY

Several new antiepileptic drugs have become available recently. Since seizures and epilepsy are common, primary care physicians are likely t o encounter a patient who is taking one of these new medications. Succ essful medical management of epilepsy requires a proper understanding of medication half-life, indications, and side effects. Felbamate has a broad spectrum of efficacy but is limited by side effects and idiosy ncratic reactions. Fosphenytoin has the efficacy of phenytoin and offe rs the advantage of intramuscular and intravenous dosing without the s ignificant adverse effects associated with intravenous phenytoin; howe ver, it is expensive. Gabapentin has minimal side effects and drug int eractions yet has limited efficacy for seizures. Lamotrigine has broad seizure efficacy but requires a slow adjustment to therapeutic levels . Topiramate has minimal drug interactions, but therapy must be initia ted slowly to avoid side effects. All of the new antiepileptics hold g reat promise in the management of patients with recurrent seizures.