[Antiepileptic drugs used in childhood. New products and new concepts].
BACKGROUND
Eight new antiepileptic drugs (AED) have been marketed in Spain since 1990 and others will soon follow.


OBJECTIVE
To review the concepts underlying the development of the new drugs, as well as their indications, efficacy and safety.


METHODS
Pharmacologic antiepileptic intervention is no longer solely directed towards an anticonvulsant effect, but also to epileptogenic prevention, disease modification and reversal of pharmacoresistance. The development of new AED, initially based on the screening of putative products in animal models, changed during the last half of the century to a rational design based on known facts about excitatory /inhibitory neuronal mechanisms. More recently, attention has focussed on pharmacogenetics. The new AED were initially indicated for partial epilepsies, but some have been shown to have a broader clinical spectrum. Some show the ideal pharmacokinetic mechanisms, avoiding hepatic metabolism and protein binding. Drug interactions and adverse effects, especially severe idiosyncratic adverse effects, are rare, although there are some exceptions. In most cases, however, seizure control does not seem to be better than with the classic AED. Because of the specific characteristics of childhood epilepsy and pharmacokinetics, as well as the regulations governing the development of clinical trials, the use of new products in children is circumspect, which in turn delays the access of such patients to a possible therapeutic benefit.
Garaizar Axpe
C
C
Unidad de Neuropediatría. Hospital de Cruces. Baracaldo. Vizcaya. España. cgaraizar@hcru.osakidetsa.net
Villaverde Bello
A
A
Pérez Concha
T
T
Herrera Isasi
M
M
Alvarez Ruiz de Larrinaga
A
A
D000927:Anticonvulsants / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D004347:Drug Interactions; D004351:Drug Resistance; D006801:Humans
D000927:Anticonvulsants