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Lamictal is an anti-epileptic medication, also called an anticonvulsant.

Lamictal is used alone or in combination with other medications to treat seizures in adults and children who are at least 2 years old. It is also used to delay mood episodes in adults with bipolar disorder.

Lamictal may also be used for purposes other than those listed in this medication guide.
Important information about Lamictal
Lamictal may cause severe or life-threatening skin rash, especially in children and in people who are allergic to other seizure medications. Serious skin rash may also be more likely to occur if you are taking Lamictal together with valproic acid (Depakene) or divalproex (Depakote). Seek emergency medical attention if you have a fever, sore throat, swollen glands, and headache with a severe blistering, peeling, and red skin rash.

If you have to stop taking Lamictal because of a serious skin rash, you may not be able to take it again in the future.

You may have thoughts about suicide while taking Lamictal. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
Do not stop taking this medication without first talking to your doctor, even if you feel better. You may have increased seizures if you stop taking Lamictal suddenly. You will need to use less and less before you stop the medication completely. Contact your doctor if your seizures get worse or you have them more often while taking Lamictal. Carry an ID card or wear a medical alert bracelet stating that you are taking Lamictal, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking a seizure medication. Lamictal can cause side effects that may impair your vision or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Taking this medication during early pregnancy can increase the risk of the baby being born with cleft lip or cleft palate. Tell your doctor if you are pregnant or if you become pregnant during treatment.
Before taking Lamictal
You should not use Lamictal if you are allergic to lamotrigine.

Before taking Lamictal, tell your doctor if you are allergic to any other seizure medications, or if you have:
* kidney disease;
* liver disease; or
* heart disease.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Lamictal.

You may have thoughts about suicide while taking this medication. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.
FDA pregnancy category C. This medication may be harmful to an unborn baby. Taking this medication during early pregnancy can increase the risk of the baby being born with cleft lip or cleft palate. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Your name may need to be listed on a Lamictal pregnancy registry when you start using this medication.

Epilepsy is a very bag medical condition. It may affect you or your children. It is very important to treat it and to do so from the beginning. There some solutions to do it and you should be aware of them.
Drugs can work very well for many people with epilepsy, which allows them to lead full and normal life. Other, easier to find resources, either because of side effects or simply because it does not work. While many take drugs to be effective, it is a fact that 20-30 percent of people with epilepsy do not respond well to drug therapy. If medication does not prove effective, your doctor may try a higher dose or different medicine or combination of two medicines.

Very rare fight epileptic drugs may lead to more frequent seizures. If this happens your doctor may check the diagnosis. Doctors usually start patients with epilepsy off the lowest dose of anti-epileptic, and then build it to reduce the side effects. What you need depends on various factors such as building and body, to influence how your body processes the medicine and how easy you are to treat epilepsy.

Too high a dose can cause toxicity. Symptoms of poisoning range from drug treatment. If a person gets too much phenytoin, they often become very unstable and may have more frequent seizures. Carbamazepine toxicity usually begins with double vision and drowsi ¬ tion. Another reason why this drug can sometimes seem Seizures will increase if the appropriate type of seizure medication aggravates other types of seizure. Carbamazepine, for example, are effective against tonic-clonic seizures, but not against absence seizures.

There is some confusion about brand vs. generic drugs. Almost all drugs have two names. The first is a common one, even the scientific name of the product that is internationally recognized. Branded drugs name created by individual pharmaceutical companies have produced them. Actual medication is the same, but the problem may occur if you switch from one to another - for example, if you go on Tegretol (brand) with Carbamazepine (generic). This is because sometimes there are small differences in the way drugs are produced. It is best to stick to the type of epilepsy pill are prescribed first, whether branded or generic. Sometimes change may precipitate seizures or side effects. Back man sometimes seizure control may improve or reduce their consequences.

Changing drug treatment
Before treatment was changed on several issues must be considered:

1 is epilepsy? In the misdiagnosis rate is estimated to be between 10 and 25 percent.

2 If it is epilepsy, what type of seizure disorder or syndrome?
Many youth with myoclonic epilepsy (tonic-clonic seizures and myoclonic jerks first thing in the morning) Go undiagnosed, as appropriate leading questions are not asked about myoclonic jerks or early morning tonic-clonic seizures. Specific SYN ¬ Drome responded extremely well to sodium valproate, but carbamaze ¬ pine to create Seizures worse.

3 Are there more appropriate to combat epileptic drugs? All anti-epileptic drugs appeared equally effective (or ineffective!) Confiscation weak, but in primary and symptomatic generalized epilepsy Seizures respond best to sodium valproate, lamotrigine as a second line treatment.

4 provide an adequate drug dose? It is amazing how many people have more than one drug, all drugs in inadequate doses. Results of clinical audit are provided in London suggest that the Seizures can be halved to about one third of the people by reducing the number of drugs in monotherapy and in adequate drug dosage. It is interesting 10% became seizure free as a result of this simple maneuver.

5 you take drugs? If this is a problem that is worth trying to simplify drug therapy to a maximum of twice a day. In midday dose is very easy to forget everything, but gabapentin has a long half-life, to give either once or twice daily.

Epilepsy is a bad and horrible disease. It is a common disease nowadays and it may affect anyone. It has no importance if you are old or young, rich or poor anyone mat suffer from this terrible disease. So it is very important to treat it and not to let it go to further.

People with fibromyalgia frequently have other comorbid illnesses, such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), migraines, restless legs syndrome (RLS) and irritable bowel syndrome (IBS). Fibromyalgia commonly occurs together with autoimmune diseases, especially rheumatoid arthritis and lupus (SLE), but it is not thought to be an autoimmune illness. The exact mechanism that causes the illness is not fully understood yet.

Lyrica And Cymbalta

The FDA has approved two medications for fibromyalgia: pregabalin (Lyrica) in June 2007 and duloxetine (Cymbalta) in June 2008. Pregabalin is an anticonvulsant (epilepsy drug), though it is used more often for pain disorders. Duloxetine is an SNRI antidepressant (serotonin and norepinephrine reuptake inhibitor), also used for diabetic neuropathy and stress incontinence.

Despite being in entirely different classes of drug, both Lyrica and Cymbalta can help pain, sleeping problems, fatigue, cognitive impairment, depression and anxiety caused by fibromyalgia, though they don’t help everyone and even if you do benefit, you might not get improvement in all of the listed symptoms.

Anticonvulsants And Antidepressants

Generally almost all anticonvulsants, including older names like carbamazepine and lamotrigine and newer players like topiramate, zonisamide and levetiracetam can help the symptoms of fibromyalgia. There are big differences in modes of action among drugs in this class, so even if one does not work or produces intolerable side effects, another one might be worth a try. They tend to be especially helpful for pain, mood problems and migraine prevention, often also for sleep.

The same goes for antidepressants, too. The reason they are used in fibromyalgia is not that fibromyalgia is a psychiatric disorder, but they are also used in many other painful conditions like migraines, chronic headaches, neuropathic pain and IBS. It is thought that fibromyalgia may be associated with a deficit of serotonine and norepinephrine.

The SSRI antidepressants like fluoxetine (Prozac) are generally not so effective for pain. Many other antidepressants, however, also affect norepinephrine. These include tricyclic antidepressants such as amitriptyline (Elavil) and imipramine which have been used to treat fibromyalgia since the 1980s. They are used in very small doses, usually much smaller ones than would be used for depression. They are especially effective for sleep, but often cause too many side effects.

NMDA Antagonists

A third promising class of drugs is NMDA receptor antagonists. The NMDA receptor is thought to be overactive in fibromyalgia and downregulating it could relieve all symptoms of the condition. NMDA antagonists include the cough suppressant dextromethorphan, amantadine which is used for influenza and Parkinson’s disease, the Alzheimer’s drug memantine and riluzole, a new drug used for amyotrophic lateral sclerosis (ALS).

Other drugs that also downregulate the NMDA receptor include e.g. calcium channel blockers, many anticonvulsants, some opioids (methadone and dextropropoxyphene) and the muscle relaxants dantrolene and orphenadrine. Magnesium and the amino acid taurine may also have this effect.

Gabapentin and Pregabalin both of which are anticonvulsants can be used for chronic pain (especially migraines and neuropathy). They include drugs with very different modes of action, but are also effective for sleeping problems, anxiety and depression.

Anticonvulsants, also called antiepileptic drugs (abbreviated “AEDs”), are a diverse group of pharmaceutical used in the treatment of epileptic seizures. There has also been an increase in their use with treatment of bipolar disorder, since it seems to act as mood stabiliser.

They can also relieve fatigue, flu-like symptoms, cognitive dysfunction, neurological symptoms, irritable bowel syndrome (IBS), bladder problems, restless legs, muscle tension and multiple chemical sensitivity. Their ability to tackle many symptoms at once has made them one of the most important drugs in the treatment of CFS/ME.

Because anticonvulsants work by different mechanisms, their side effects vary too - obviously these depend on the individual and some people do not get any side effects. The older ones can very rarely cause liver problems and other severe reactions. On the other hand, the newer ones are more prone to causing sedation.

Headaches, dizziness and vision impairment are common side effects. Some anticonvulsants can cause weight gain, but a few (topiramate, vigabatrin and zonisamide) may lead to weight loss.

Gabapentin (Neurontin) is one of the most popular treatments for CFS/ME and fibromyalgia. It can alleviate a wide variety of problems from interstitial cystitis to hot flashes. It is often used for anxiety and mood problems. It is also a popular pain treatment, especially for burning or electric shock-like neuropathy.

Pregabalin (Lyrica) Pregabalin is very similar to gabapentin, but may be slightly better tolerated. It was the first FDA-approved drug for fibromyalgia, though there is no evidence that it is more effective in this use than the less expensive gabapentin.

It is used for treating pain caused by neurologic diseases such as postherpetic neuralgia as well as seizures. It also is used for treating fibromyalgia. The mechanism of action of pregabalin is unknown.

Pregabalin binds to calcium channels on nerves and may modify the release of neurotransmitters (chemicals that nerves use to communicate with each other). Reducing communication between nerves may contribute to pregabalin’s effect on pain and seizures.

pregabalin was shown to provide improvement of pain in patients with fibromyalgia, a chronic and debilitating pain syndrome and is also shown shown to improve sleep and fatigue levels.

Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain that is frequently associated with fatigue and sleep disturbances and is is a complaint that is frequently associated with CFS. It is estimated to affect two percent of the population, or 5.6 million Americans, and occurs most frequently in women.

The double-blind, placebo-controlled monotherapy study involved 529 patients diagnosed with FMS. Patients were randomized to receive placebo or pregabalin (150 mg, 300 mg or 450 mg per day) for eight weeks. The study evaluated the efficacy and safety of pregabalin for the treatment of pain and associated symptoms such as sleep and fatigue. Patients were required to characterise and record their pain on a daily basis in detailed diaries.

Pregabalin-treated patients (450 mg/day) showed statistically significant improvements in pain compared to those who received placebo. Further, 29 percent of pregabalin-treated patients reported at least a 50 percent reduction in pain, compared with a reduction of 13 percent for patients who received placebo, a difference that was statistically significant.

In addition, pregabalin significantly improved sleep quality and fatigue!!

To demonstrate improvements in the core symptoms of pain, sleep and fatigue represents an important advance, particularly as there are no approved treatments for this condition.

The most common dose-related side effects reported by patients were dizziness and drowsiness. Most adverse events were mild to moderate in intensity, and many resolved during the study. Seventy-eight percent of all patients completed the study.

Developed by Pfizer, pregabalin has been studied in an extensive clinical program involving over 8,000 patients worldwide. The company has completed pivotal studies to support the filing of a New Drug Application for pregabalin for the treatment of neuropathic pain and generalized anxiety disorder and as an add-on therapy for epilepsy.

Carbamazepine (Tegretol) Carbamazepine is an old inexpensive anticonvulsant which has sometimes been used in CFS/ME. It is particularly effective for sharp and stabbing neuropathic pain. It can cause liver damage and other serious problems, so safer alternatives have mostly surpassed it and is not in widespead use today.

Oxcarbazepine (Trileptal) is a newer derivative of carbamazepine with similar efficacy and uses, but it may be less likely to cause some of the serious adverse reactions.

Lamotrigine (Lamictal) Lamotrigine affects many neurotransmitters and receptors in the brain. It also has some antiviral activity against HHV-6, a herpes virus which has been associated with CFS/ME. Some people with CFS/ME have found it extremely useful.

Unfortunately lamotrigine can cause a life-threatening rash. This is very rare, but up to 10% of the patients develop some sort of a rash (usually harmless), so the drug is often discontinued just in case.

Levetiracetam (Keppra) Levetiracetam may be the antidepressant with best tolerability and fewest side effects. It is often useful in RLS and migraine (especially migraine with aura). It may also help refractory cases of chronic pain and PTSD.

Clonazepam (Klonopin) Clonazepam belongs to benzodiazepines, a class of tranquilizer drugs. It is sometimes used for sleeping problems and for its muscle relaxing properties. It is also an anticonvulsant. Many CFS/ME and fibromyalgia experts believe that in low doses clonazepam is one of the best treatments for these illnesses.

Epilepsy is a physical state which starts in the brain. Epilepsy is characterized by recurring unprovoked seizures. Sometimes seizures are related to a provisional state, such as the exposure to drugs, the withdrawal of certain drugs, or the abnormal levels of sodium or glucose in blood. There are many various types of seizures. The kind of seizure that a person has to count on which part and which quantity of brain is affected by the electric disturbance which produces seizures. Some seizures are idiopathic, which means that the cause cannot be identified. Such seizures usually start between ages 5 and 20, but they can occur at any age.

Epilepsy is a state of the nervous system which affects 2.5 million americans. Many people develop the epilepsy like children or years of adolescence. Others develop it later in the life. For some with the epilepsy (in particular kids), the seizures become finally less frequent or disappear completely. People can have strange feelings and emotions or behave curiously. They can have spasms violent one of muscle or lose the conscience. The epilepsy has possible damage of brain of much of causes and the abnormal development of brain. The principal damage or the lack of oxygen during the birth can damage the significant electric system in the brain.

Other causes include tumours of brain, conditions genetic, the wire poisoning, of the problems being studied of the brain before birth, and the infections like meningitis or the encéphalite. Sometimes the seizures stop without treatment. Many people take antiepileptic drugs to control seizures. Antiepileptic drugs function beside reducing the abnormal setting with fire of the cortical neurons. These drugs can change the activity of the neuro-transmitters responsible for the seizures or to change the manner the ions run in and out of the neurons. The neurosurgical operations for the epilepsy can be palliative, reducing the frequency.

When the drug fails, the surgery can be performed to treat the epilepsy. There are various types of surgery which were employed. The temporal surgery of lobe is carried out to remove fabric of brain where the access epileptic starts. This type of surgery often removes a part of the cortex of the lobe, hippocampus and amygdala temporal. The corpus callosotomy is cut to divide the goods and left cerebral hemispheres. This process is made to prevent the diffusion of the seizure on a side of the brain to the other. The surgery of Hemispherectomy east remove cerebral.

While about 80 percent of people with epilepsy gain significant relief from drug therapy, the remaining 20 percent have seizures that cannot be controlled by epilepsy medications. Many of these people have a particular type of epilepsy called partial epilepsy. A new study shows that people with partial epilepsy often have seizures controlled by medications for years before their seizures become drug-resistant. The study also found that periods when seizures stopped for a year or more are common in these patients.

“This study opens the door for early identification of patients who will later develop drug-resistant partial epilepsy, which may in turn allow us to identify ways of preventing some forms of epilepsy from ever becoming drug-resistant,” says lead author Anne T. Berg, Ph.D., of Northern Illinois University in DeKalb, who is part of a large multicenter team directed by Susan Spencer, M.D., at Yale University in New Haven, Connecticut. The study was funded by the National Institute of Neurological Disorders and Stroke (NINDS) and appears in the January 28, 2003, issue of Neurology. 1

In the new study, researchers looked at patients who had surgery for drug-resistant partial epilepsy to identify factors that predict when seizures will become intractable, or no longer controllable with medications. They also studied the incidence of previous seizure-free periods in this group. Partial epilepsy results from abnormal neuronal activity that originates in a single part of the brain, usually in one of the temporal lobes.

Epilepsy is a disorder in which clusters of nerve cells, or neurons, in the brain display patterns of abnormal activity. This activity can cause a variety of symptoms, including convulsions. Physicians have described dozens of different kinds of epilepsy. “Epilepsy is not a single disorder - like cancer, it’s a multitude of disorders with varying symptoms, prognoses, and implications for specific treatment,” says Dr. Berg. Partial epilepsy accounts for about 40 to 50 percent of childhood epilepsy and 90 percent of adult-onset epilepsy, she adds. Other types of epilepsy result from abnormal neuronal activity in many parts of the brain.

In this study, researchers looked at 333 patients who had undergone surgery for partial seizures and who were part of a larger ongoing study to examine the outcomes of epilepsy surgery. Most of these patients had temporal lobe epilepsy, or TLE. The researchers examined medical records and conducted structured interviews with these patients to determine the duration, frequency, and types of seizures the patients experienced. They found that patients’ average age when they had their first seizure was 14.6 years, while the average age at which they underwent surgery was 36.7 years. The 282 patients for whom historical data were available had been diagnosed with epilepsy an average of 9 years before their epilepsy became intractable. Intractable epilepsy in this study was defined as a failure of two medications to control seizures.

The researchers also asked about previous periods when the patients had been seizure-free. About one quarter of the patients said they had had seizure-free periods of a year or more. Twenty-four patients (8.5 percent) had seizure-free periods of 5 years or more. A seizure-free period of 1 year or longer was most common in people who were younger than 5 when they were diagnosed. The results show that a history of seizure-free periods is common in people who later develop intractable seizures.

The study identified several factors that were related to the amount of time before seizures became intractable. These factors included age of onset, type of surgery the patients received, history of febrile (fever-related) seizures, and atrophy of the hippocampus, the region of the brain that is affected in TLE. Of these factors, age of onset had the strongest relationship with the amount of time until intractability, Dr. Berg says. In patients whose seizures began before age 5, it took an average of 15 years for seizures to become intractable. In patients whose epilepsy began during their 30s and 40s, however, seizures tended to become intractable immediately or within only a few years.

“Consistent with other reports, many individuals in our study did indeed have epilepsy that became intractable within a short time after its initial onset. What is startling, however, is the large number of patients who experienced prolonged periods of seizure control before their seizures became intractable,” Dr. Berg says. Based on the 15-year average time it took for early-onset seizures to become intractable, Dr. Berg says that studies of epilepsy prognosis need to proceed for at least that amount of time in order to identify patients who might develop intractable seizures late in the course of the disorder.

The results of this study pertain only to partial epilepsy, primarily TLE, and cannot and should not be generalized to other forms of epilepsy, Dr. Berg notes.

“These data give us some clues, but they only begin to scratch the surface. We need careful, prospective long-term studies in order to accurately understand the long-term prognosis of partial epilepsy,” says Dr. Berg. She and her colleagues are now conducting additional studies to determine which patients develop intractable seizures.

Suffering from sleep deprivation can have a lot of adverse side effects, and sleeplessness is even more dangerous if the person has epilepsy. Epilepsy is a common chronic neurological disorder and is associated with the seizures sufferers acquire involuntarily. The seizures are symptoms of an excessive, abnormal, or synchronous neuronal activity in the brain. It is estimated that fifty million people all over the world has epilepsy or has experienced epilepsy at one point in their lives.

Although not all epilepsies are permanent, there is no cure for it. Medications can help control epileptic shocks but epilepsy itself either lasts for certain stages of childhood or it could very well be a lifelong affliction. Also, epilepsy in itself is not a single syndrome. There are numerous precipitating factors for its occurrence, and it all culminates as an abnormal activity in the brain which causes the shock.

Although most epilepsy shocks happen spontaneously or at random, there can be triggers for epilepsy. Shock during drug and alcohol withdrawal is not considered epilepsy. The triggers can be normal day to day activities. These are called normal provocants, and it can include reading, hot water on the head, and hyperventilation. Flashing or flickering lights is a special type of reflex epilepsy called photosensitive epilepsy. Though popularly known as an epileptic trigger, only two to fourteen percent of epilepsy sufferers are affected by it. Environmental factors that can lead to an epileptic shock or seizures can be sleeping, or hypnogogia (which is the transition between being unconscious state of sleeping and waking state). Menstruation, constipation, stress and anxiety and alcohol can be other epileptic triggers.

Moreover, sleep deprivation, as most doctors and researchers have found out, is also linked with epilepsy. Epilepsy and sleep deprivation can work both ways: epilepsy can make it difficult for sufferers to go to sleep at night, and sleeplessness in turn, can lead to an epileptic shock. Epilepsy is not limited during a person’s waking state: there can be full or partial seizures during sleeping. People who are epileptic are also more likely to develop sleeping disorders compared to the rest. Insomnia is not the only adverse effect of epilepsy. Epileptics are also more likely to develop obstructive sleep apnea (restriction in the airways, causing pauses in breathing while asleep), restless leg syndrome, among others.

Medications to control the seizures can also be the cause why epileptics have a harder time sleeping. It has been found that these medicines can cut their sleeping time or cause erratic sleeping habits. What is worse is that since being deprived of sleep can cause more seizures, and epilepsy (and medications) can cause sleep deprivation, epileptics can be caught in a vicious cycle. It is just like connecting the dots: since sleep deprivation can affect the brain, and epilepsy shock is caused by episodic abnormal electrical activity in the brain, the link between epilepsy and sleep deprivation is a dangerous combination.

Dealing with both epilepsy and sleep deprivation is a serious matter. One has to consult a doctor, and epileptics might need to change their daily habits, their environment, and so on. It takes a great deal of effort, but with the help of doctors and professionals, it can be managed.

Epilepsy is a physical condition that occurs when there is a sudden, brief change in how the brain works. When brain cells are not working properly, a person’s consciousness, movement, or actions may be altered for a short time. These physical changes are called epileptic seizures. Therefore, epilepsy is sometimes called a seizure disorder. Epilepsy affects people in all nations and of all races.

What Causes Epilepsy

Any condition that keeps blood or oxygen from getting to the brain (e.g. hardening of the arteries)

Alzheimer’s disease or other diseases that change the brain’s structure

Dozens of genetic syndromes representing a variety of seizure patterns may account for the different forms epilepsy.

A genetic cause has been identified for at least some cases of juvenile myoclonic epilepsy, which represents 10% of all epilepsy cases. (Such research and other studies have pointed to the GABA signaling system as an important player in many cases of epilepsy.)

Symptoms of Epilepsy

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For many patients, the event is the same thing over and over, while some people have many different types of seizures that cause different symptoms each time. The type of seizure a person has depends on a variety of many things, such as the part of the brain affected and the underlying cause of the seizure.

Experiencing changes in the way things look, smell, feel, taste, or sound.

Experiencing an intense feeling of déjà vu (a feeling that these events have happened before).

Epileptic seizures often happen without warning, although some people may have an aura at the beginning of a seizure. A seizure ends when the abnormal electrical activity in the brain stops and brain activity begins to return to normal. Seizures may be either partial or generalized.

How is epilepsy diagnosed?

First, a detailed history is needed. A physical and neurologic exam are performed by your veterinarian, a panel of laboratory tests are run, and sometimes x-rays (radiographs) are taken. If a cause of the seizure can not be identified, the condition is diagnosed as idiopathic or primary epilepsy. There is no test to diagnose epilepsy per se, our tests simply rule out other causes of seizures.

How Can You Treat Epilepsy

The goal of epilepsy treatment is to treat, and prevent, seizures.

In some cases, seizures can occur because of the presence of a substance, infection, or other condition. These can be stopped by treating the fever, the poisoning, low blood sugar or the infection, if this is discovered to be the cause of the seizures.

Some medications can be taken daily in order to prevent seizures altogether or reduce the frequency of their occurrence. These are termed “anticonvulsant” or “antiepileptic” drugs (sometimes AEDs). All such drugs have side effects which are idiosyncratic and others which are dose-dependent; it is not possible to predict who will suffer from side effects or at what dose the side effects will appear.

Because of serious side effects, felbamate is not recommended as first-line therapy in the treatment of seizures. The manufacturer recommends its use only in patients who do not adequately respond to alternative therapy and whose epilepsy is so severe that the substantial risks of aplastic anemia and hepatic failure are deemed acceptable.8 Its use requires that the physician be thoroughly familiar with the drug. The manufacturer recommends that written consent be obtained before initiation of therapy.

Monotherapy in adults should begin with 1,200 mg of felbamate daily, given in divided doses every six to eight hours. Daily dosages should increase by 600 mg every two weeks to a total daily dosage of 2,400 to 3,600 mg. As adjunctive therapy, treatment should begin at 1,200 mg daily, given in divided doses every six to eight hours. If the patient is taking phenytoin, valproic acid or carbamazepine, a 20 to 35 percent reduction in the dosage of these drugs is recommended during felbamate therapy. Levels of antiepileptic drugs should be followed as the dosage of felbamate is increased to 2,400 to 3,600 mg daily.

The beginning dosage of felbamate in children aged two to 14 years with Lennox-Gastaut syndrome is 15 mg per kg, given in three to four divided doses. Dosages of other antiepileptic drugs should be reduced by 20 percent, with further reductions based on side effects or drug levels. The daily dosage of felbamate should increase by 15 mg per kg weekly, to a maximum of 45 mg per kg.

The most common side effects include anorexia, vomiting, insomnia, nausea, headache, dizziness and somnolence.10 One overdose has been reported. The patient improved with supportive care. Clinical effects of overdose included epigastric distress and tachycardia.

After initial marketing of the drug, two very serious toxic effects appeared: aplastic anemia and hepatic failure. The risk of aplastic anemia in patients taking felbamate is 100 times greater than it is in the general population. One in every 3,600 to 5,000 patients taking felbamate will have aplastic anemia. The fatality rate of this complication approaches 30 percent. Aplastic anemia may not manifest itself until several months after initiation of treatment, and patients may remain at risk for an undetermined amount of time after treatment is discontinued. The syndrome may begin without warning and may not be reliably detected by routine testing. Patients taking felbamate should remain alert for signs of infection, bleeding and easy bruising, or symptoms of anemia such as fatigue or weakness.

Hepatotoxicity leading to hepatic failure is estimated to occur in one in every 24,000 to 34,000 patients taking felbamate. Felbamate should not be used in patients with a history of hepatic dysfunction.

The need for monitoring drug levels has not been established. However, baseline laboratory testing should include a complete blood count, platelet count and reticulocyte count, as well as determination of liver enzyme levels. Hematologic evaluations should be performed frequently during treatment and after discontinuation of treatment. Liver enzyme levels should be determined every one to two weeks, and felbamate therapy should be discontinued if the aspartate aminotransferase, alanine aminotransferase or bilirubin levels increase above baseline.