[New antiepileptic drugs: a review and personal contribution]

In drug-resistant epilepsy the use of VGB, LTG, oxcarbazepine, FBM and GBP resulted in at least a 50% improvement in 20% to 60% of such patients treated and in 7% led to complete seizure control. In the long term, VGB may lose its efficacy and give rise to tolerance phenomena. Another frequent disadvantage of VGB is poor compliance owing to the large number of tablets needed to achieve the necessary dose (2-3 g). VGB may also induce a worsening of myoclonic epilepsies and seems ineffective in absences; whereas it can induce a good response in West's syndrome. LTG and FBM yielded a good response in idiopathic generalized epilepsies and were effective in refractory partial seizures, West's syndrome and Lennox-Gastaut's syndrome. After being suspended because of the risks of bone-marrow aplasia and liver toxicity, FBM trials began again in 1995, use of the drug being restrict to drug-resistant partial epilepsies and to Lennox-Gastaut's syndrome. Oxcarbazepine has an efficacy equal to that of CBZ, but had fewer side effects and very few interactions with other drugs. Although GBP has few side effects and acts as an anticonvulsant in subjects with resistant partial epilepsy, some reports suggest that it can lose its efficacy around the 18th or 19th month.