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 REVIEW ARTICLE
Year : 1996  |  Volume : 28  |  Issue : 1  |  Page : 1-10

Antiepileptic agents: Newer generation



Correspondence Address:
A K Sharma


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Source of Support: None, Conflict of Interest: None


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The standard antiepileptics, though effective in most cases of epilepsy, suffer from various limitations in the form of serious side effects, need for plasma drug concentration monitoring and interactions with a number of drugs. Recently, a number of compounds have been shown to possess antiepileptic properties and are free from most of the above mentioned drawbacks. Vigabatrin, stiripentol and progabide are potent antiepileptics and act through GABAergic system. Vigabatrin and stiripentol are effective in refractory partial epilepsy. Stiripentol is also effective in absence seizures, in contrast vigabatrin increases frequency of absence seizures. Stiripentol offers an added advantage of producing a feeling of well being. Progabide, a GABA agonist, has not been well accepted clinically because of its controversial clinical efficacy and hepatotoxicity. Lamotrigine, oxcarbazepine, fosphenytoin, flunarizine and topiramate have antiepileptic profile similar to phenytoin. The first three of these compounds act through Na+ channel, however the mechanism of flunarizine and topiramate is not clear. Fosphenytoin and oxcarbazepine are prodrugs and offer advantages of better bioavailability and less toxicity. Lamotrigine, flunarizine and topiramate are effective in partial seizures. Midazolam, a benzodiazepine, is effective even in status epilepticus refractory to diazepam and is considered drug of choice after lorazepam and phenytoin in refractory status epilepticus. Felbamate, gabapentin and allopurinol are effective in refractory generalised epilepsy. In addition, felbamate and gabapentin are also effective in refractory partial epilepsy. NMDA receptor antagonists, potassium channel openers and fluoxetine are potent antiepileptics but have been studied only in animal models. Although, the emergence of these new compounds have opened a new vista in the treatment of epilepsies but most of these compounds are under investigation and vigabatrin, lamotrigine, felbamate, oxcar-bazepine and gabapentin are most studied of these antiepileptic compounds.






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