CaseRepClinPractRev 2001; 2(1):70-76
Conventional drugs provide appropriate protection to ca 2/3 of patients with epilepsy and are responsible for numerous side effects, especially in polytherapy. The recent findings concerning synaptic and membranous mechanisms of epileptogenesis, and, in particular, the significance of reduced inhibitory GABA-ergic neurotransmission and changes in membranous conductivity of sodium and calcium ions, have contributed during the last decade to the development of numerous novel antiepileptic drugs. Among those, vigabatrin, lamotrigine, gabapentin, tiagabine, felbamate and topiramate are the best known and most promising novel drugs. Lamotrigine, like traditional drugs - phenytoin and carbamazepine - limits the spread of convulsive activity by blocking the activity of sodium channels. Vigabatrin, gabapentin and tiagabine enhance the effect of GABA-ergic inhibition, similarly to phenobarbital and benzodiazepines. Felbamate and topiramate demonstrate multidirectional activity, modifying both inhibitory and excitatory synaptic processes. The novel drugs, currently used primarily in the cases of drug-resistant epilepsy, have extended the scope of available effective treatment, being additionally well-tolerated by the patients owing to their favorable pharmacokinetic properties.
Keywords: Epilepsy, novel drugs, mechanisms of activity