[Evaluation of tiagabine efficacy in different groups of patients with epilepsy]

The aim of study is to discuss from a clinicians viewpoint the use of tiagabine in the clinical setting, in particular how we can relate our current knowledge to individuals in our clinics. The choice for individual and the clinician is multi-layered dependent on many factors. Namely is based on patient characteristics, their beliefs and wishes, age, seizure type or syndrome and comorbidity. The next factor influencing choice is drug characteristics; pharmacology, mode of action, efficacy, tolerability, practical use and cost. Very important is fear of unknown. Particularly important are new drugs, which can be safety use in groups of special concern like children, women of reproductive age, the elderly, patients with psychiatric illness and mental handicaps. In these cases the risk of fetal malformations, interactions with other drugs, safety profile should be taken into consideration. Tiagabine represents an important new therapeutic option for patients with drug resistant partial seizures. The role of tiagabine in the management of patients with intellectual disability is especially emphasised since tiagabine has a low side-effects profile in the cognitive area. Comparison of data for new antiepileptic drugs provide information for selection among treatments when a second drugs is needed to improve control of seizures. However, there are numerous caveats in use of these summary data. First, the data from clinical trials cannot be compared directly because of variability in placebo response and potentially in other population characteristics. Second, the needs of individual patients differ.

There is important to stress that no controlled clinical trials have provided algorithm for the best add-on drug or combination of drugs. So there is need to describe the homogenic groups of patients and final choice should be based on the need of the individual patient (sex, age, pregnancy, mental status) for superior seizure control versus minimal adverse effects.