[New antiepileptic drugs: new therapeutic options]

Introduction of new generation antiepileptic drugs on the French market has considerably diversified our conventional therapeutic schemes for epilepsy. New arrivals, topiramate, tiagabine and oxcarbazepine, will further amplify these changes. Compared with conventional drugs, these new products present more favorable pharmacokinetic properties, with no or very weak interactions and better tolerability, especially concerning cognition. These new agents should be used in accordance with their spectrum of activity, which depends on their mechanism of action. In add-on trials in partial epilepsy patients, all these new products have shown efficacy in partial and secondarily generalized seizures. Seizure frequency is reduced by at least 50% in 30 to 50% of the patients. Some of these drugs have a broader spectrum, also exhibiting efficacy for the different seizure types of generalized, symptomatic or idiopathic epilepsy. Gabamimetic agents may have worsening effects in some patients with generalized epilepsy, especially with absence or myoclonic seizures. The most obvious benefits, some patients become seizure-free, are obtained in patients with intermediate severity given a two-drug regimen including one of these new agents. For children progress has been less rapid but prognosis, including cognitive outcome, has been considerably improved, for example in infantile spasms with vigabatrin and in Lennox-Gastaut syndrome with lamotrigine and felbamate, the latter drug being highly toxic. For the moment in France, authorities have limited the use of all these new antiepileptic drugs to adjunctive therapy for epilepsy resistant to conventional drugs. Recent monotherapy data have however demonstrated similar efficacy and better tolerability. Once the pivotal, controlled studies have enabled regulatory approval, all these compounds will have to undergo large-scale evaluation in order to better define dosages, long-term tolerability, indications and possible contra-indications in the various epileptic syndromes, including childhood epilepsy.