Levetiracetam Oxcarbazepine

Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Generalized seizures absence (newly diagnosed) ... 

Marson AG et al Levetiracetam, oxcarbazepine, remacemide and zonisamide for drug resistant localization-related epilepsy A systematic review. Epilepsy Res 2001 46 259. 

Leppik IE. Three new drugs for epilepsy levetiracetam, oxcarbazepine, and zonisamide. J Child Neurol. 2002 f7 SuppI f S53-7. 

Schachter SC. The next wave of anticonvulsants focus on levetiracetam, oxcarbazepine and zonisamide. CNS Drugs 2000 14 229 9. 

In a Cochrane Collaboration meta-analysis of trials of zonisamide, levetiracetam, oxcarbazepine, and rema-cemide, there were no significant differences in efficacy among the four drugs (4). The relative risks for treatment withdrawal were also not significantly different. 

Marson AG, Hutton JL, Leach JP, Castillo S, Schmidt D, White S, Chaisewikul R, Privitera M, Chadwick DW. Levetiracetam, oxcarbazepine, remacemide and zonisamide for drug resistant localization-related epilepsy a systematic review. Epilepsy Res 2001 46(3) 259-70. 

Phenobarbital Phenytoin Topiramate Valproate Oxcarbazepine Topiramate Second-line Clobazam6 Gabapentin Levetiracetam Phenytoin Tiagabine... 

U.S. Expert Panel 2005 Carbamazepine Lamotrigine Oxcarbazepine Levetiracetam ... 

Vigabatrin (irreversible GABA aminotransferase inhibitor), zonisamide, lamotrigine (217) (glutamate inhibitor), oxcarbazepine (218), levetiracetam (219), piracetam, tiagabine (220),... 

Partial seizures Carbamazepine Phenytoin Lamotrigine Valproic acid Oxcarbazepine Gabapentin Topiramate Levetiracetam Zonisamide Tiagabine Primidone, phenobarbital Felbamate... 

Bromide (1857) was the first drug to be used for the treatment of epilepsy, but it is now obsolete. Phenobarbital, introduced in 1912, controlled patients resistant to bromides. The next success was the discovery in 1938 of phenytoin (a hydantoin) which is structurally related to the barbiturates. Since then many other drugs have been discovered, but phenytoin still remains a drug of choice in the treatment of major epilepsy. Over the past ten years there has been a dramatic increase in the number of new anticonvulsant drugs (vigabatrin, gabapentin, lamotrigine, topiramate, oxcarbazepine, levetiracetam), but none has been shown to be superior to the major standard anticonvulsants (phenytoin, carbamazepine and sodium valproate). 

A review of the second-generation anticonvulsants reveals that screening or serendipity led to the development of felbamate (10), 1am-otrigine (11), zonisamide (13), topiramate (15), and levetiracetam (16) on the other hand, clobazam (4d) and oxcarbazepine (12) were developed by structural variation of known agents (78). Only three, vigabatrin (8), gabapentin (9), and tiagabine (14), were developed by mechanism-based rational development (78). 

Information about the concurrent use of oxcarbazepine and other antiepi-lepties is limited, but growing. The overall picture seems to be that, oxcarbazepine is a less potent enzyme inducer than carbamazepine, and therefore it does not markedly affect the serum levels of other antiepilep-ties. If oxearbazepine is substituted for carbamazepine, be aware that drug levels of some other antiepileptics may rise. High oxcarbazepine doses may inerease phenytoin levels, and the manufacturer notes that a decrease in the phenytoin dose may be required. The clinical relevance of the modest reductions in lamotrigine levels is uncertain. For mention of modestly reduced levetiracetam levels, see Levetiracetam + Other antiepileptics , p.543. 

Drug overdose Of 16 796 toxic exposures to antiepileptic drugs (phenytoin, valproic acid, and carbamazepine) in the USA in 2006, 12 resulted in death, as reported by the US Toxic Surveillance System [67 ]. Some specific problems determined by overdose of some old and new antiepileptic drugs have been briefly reviewed. For example, topiramate can cause a significant metabolic acidosis, lamotrigine Stevens-Johnson syndrome, oxcarbazepine hyponatremia, and levetiracetam psychosis. Possible adoption of guidelines for critical care management of overdose are discussed. 

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