Table 2.
Overview of current drug treatments for epilepsy
| Drug | Resumé | Knowledge required by non-specialist doctors
|
||
|---|---|---|---|---|
| Know of | Know about | Know how to use | ||
| Carbamazepine | Premier league: for partial or generalised tonic-clonic seizures. Tolerability generally good in children and younger adults, relatively less good in elderly people. Allergic reactions (rash) fairly common. Enzyme inducing drug | Yes | Yes | Yes |
| Valproate | Premier league: for generalised (both tonic-clonic and absence) and partial seizures. Weight gain often a problem. Allergic reactions uncommon. Not an enzyme inducing drug | Yes | Yes | Yes |
| Lamotrigine | Recently promoted (monotherapy licence), wide spectrum of activity; may join first league. Allergic reactions (rash) fairly common and occasionally severe | Yes | Yes | Perhaps |
| Phenytoin | Formerly in premier league, now used less because of side effects. Spectrum of activity similar to carbamazepine. Narrow therapeutic window plus complex pharmacokinetics demand monitoring of drug concentration | Yes | Yes | Perhaps |
| Vigabatrin | Recent warning about visual field defects makes specialist review desirable (patients may require visual field testing) | Yes | Perhaps | − |
| Gabapentin | Not very effective as additional treatment in severe epilepsy, but may have a future as monotherapy | Yes | Perhaps | − |
| Clobazam | Has valuable special uses, particularly when seizures occur in clusters | Yes | Perhaps | − |
| Topiramate | For treating severe epilepsy | Yes | − | − |
| Tiagabine | Just launched in Britain; place in clinical practice still to be established | Yes | − | − |
| Phenobarbitone | Formerly used widely in cases of refractory epilepsy; may still have a role when other treatments fail. Specialist opinion on withdrawal of drug is advisable | Yes | Perhaps | − |
| Primidone | Formerly used widely in cases of refractory epilepsy | Yes | − | − |
| Clonazepam | Formerly used widely in cases of refractory epilepsy; may still have a role when other treatments fail. Specialist opinion on withdrawal of drug is advisable | Yes | Perhaps | − |
| Ethosuximide | Alternative to valproate for petit mal seizures only | Yes | Perhaps | − |