Risks and benefits of new antiepileptic agents in children
New antiepileptic drugs (AED) have generally a good pharmacokinetic profile. Their mode of action remains imperfectly known. Gabapentin (GBP), oxcarbazepine (OCBZ), topiramate (TPM), vigabatrin (VGB) and tiagabine (TGB) are mostly effective for partial seizures; lamotrigine (LTG) is efficacious for both partial and generalized seizures, it is also active in treatment of Lennox-Gastaut syndrome for which felbamate (FBM) is also effective. West syndrome often responds to VGB. The tolerance of the new AED is generally satisfactory but some serious, late side-effects have become apparent. Because of such possible toxicity, of the cost and of the remaining uncertainties about indications, the new AED are used mostly as add-on therapy for epilepsies resistant to conventional AED or as secondary monotherapy following withdrawal of other drugs used as monotherapy. Some new AED (LTG, GBP, TPM, OCBZ) have proved equal or sometimes superior to conventional agents. They may be especially useful in the treatment of certain resistant epilepsy syndromes such as Lennox-Gastaut and West syndromes for which conventional drugs often fail.