[Drug treatment of epilepsy]

The presently preferred anticonvulsives in adults are carbamazepine and valproate. Before the age of 10 years valproate is a second-choice drug only, on account of its hepatotoxicity in patients of this age. Alternatives in generalized primary grand mal seizures are phenobarbital, possible also valproate and phenytoin; in petit mal seizures ethosuximide. At present, numerous substances are being tested for their suitability as anticonvulsives. Those at the most advanced stage of clinical testing are: gabapentine, lamotrigine, oxcarbazepine, progabide, vigabatrin. Among the adverse reactions, the hepatotoxicity of valproate is particularly topical, making comprehensive laboratory examinations mandatory; however, these tests have little prognostic value. During pregnancy the seizure frequency may change. In most patients, the blood levels of the anticonvulsives decrease, despite constant dosage. In the newborn vitamin K1 prophylaxis is mandatory to prevent bleeding. The use of anticonvulsives does not contraindicate nursing.