Felbamate: new preparation. May benefit multiresistant epileptic patients

Efficacy of this antiepileptic in the Lennox Gastaut syndrome is limited but there are no really effective alternatives for this severe form of epilepsy. Felbamate can have life-threatening adverse effects, including bone marrow aplasia and acute liver failure. These adverse effects mean that felbamate must be reserved for patients who are refractory to other correctly prescribed and administered antiepileptics, alone or in combination. Liver function tests and blood counts, including platelets, must be done before starting felbamate and then every fortnight during treatment. Felbamate can also interact with most antiepileptics, hence the need for close clinical monitoring to ensure the tolerability of the entire treatment regimen; plasma assays of the other antiepileptics may also be necessary. There is, however, no reason to monitor plasma concentrations of felbamate, at least pending further data.