Second generation anticonvulsant medications: their use in children

The pharmacotherapy of seizure disorders has long relied on a few standard medications such as phenobarbital, phenytoin (Dilantin), valproate (Depakote), and others that represent the "first generation" of anticonvulsants. This article reviews the newer, "second-generation" anticonvulsants that were developed in the last decade. The addition of these second-generation agents has doubled the number of therapies available for the treatment of seizure disorders. They include felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), tiagabine (Gabitril), topiramate (Topamax), and zonisamide (Zonegran). This article describes the known side effects of the second-generation agents and reviews the adverse reactions of the first generation of anticonvulsants as a guide to potential toxicities. Reference tables are included that note usual dosages, available dosage forms, and tablet imprint. In addition, this article describes monitoring parameters and gives specific information regarding the use of these agents.