[Anticonvulsant drug therapy in children and adults. Practical guide for single and multiple dosage]

The available scientific literature rarely addresses the important practical issue of how to establish and withdraw antiepileptic treatment. Initiation of antiepileptic therapy is mainly based on personal experience. With regard to the few data focussing on this topic and on the background of the authors' personal experience and discussions with other experienced epileptologists the authors attempt to propose a rational concept. Age-related pharmacokinetic properties of anti-epileptic drugs are discussed. Recommendations for initial starting dose, titration procedures, target dosages and number of daily doses for both standard and new antiepileptic drugs are given. Dosages for children are given on a mg/kg body weight basis. Indications and limitations for determination of drug levels are provided. Withdrawal of antiepileptic therapy has been subject of recent prospective studies in children and adults providing important prognostic factors. Etiology of the epilepsy, syndromic classification, results of neurological investigation, EEG and the personal situation of the patients have to be considered. Current knowledge is reviewed with emphasis on practical aspects of when and how to withdraw antiepileptic drugs. This review emphasizes the urgent need of further prospective studies.