[New epileptic treatments. Current modalities and their utilization].

NINE NEW MOLECULES

Since 1990, nine antiepileptic drugs have been launched in France: vigabatrin (Sabril), felbamate (Taloxa), gabapentin (Neurontin), lamotrigine (Lamictal), tiagabine (Gabitril), fosphenytoin (Prodilantin), topiramate (Epitomax), oxcarbazepine (Trileptal) and levetiracetam (Keppra). INDICATIONS EXTENDING: The indications for these new antiepileptic molecules, initially indicated in the case of insufficient efficacy or intolerance to first (phenobarbital, phenytoin) or second generation (valproate, carbamazepine) antiepileptics are in fact progressively extending, notably with the approval of first line monotherapy with gabapentin (partial epileptic seizures in adults), lamotrigine (partial and generalised epilepsy, and in addition in children) and oxcarbazepine (partial epilepsy). PROBLEMS OF TOLERANCE: Two molecules (vigabatrin and felbamate) had their prescription reduced because of rare but severe side effects, which had not been detected during the studies preceding marketing authorisation. The availability of these new antiepileptics has broadened and diversified but also complicated the medical management of epilepsy. Although the efficacy of the molecules has been demonstrated, particularly in certain specific indications, some products (felbamate, tiagabine, topiramate) exhibit an average efficacy/safety profile, whereas others (felbamate, lamotrigine) expose the patients to rare but potentially severe idiosyncratic effects. Moreover, some drugs with limited spectrum (vigabatrin, gabapentin, tiagabine and oxcarbazepine) may even worsen the symptoms of epilepsy. INTEREST AND LIMITS: The new antiepileptics often lead to remarkable results in cases of moderate epilepsy. However, they do not appear to change the conditions of the small percentage of patients who suffer from truly severe epilepsy. More targeted indications, notably in children, warrant specification in rigorous clinical trails that are still difficult to elaborate. All these data justify the efforts made in the development of new drugs, and the emergence of surgical and alternative approaches.