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The Next Wave of Anticonvulsants

Focus on Levetiracetam, Oxcarbazepine and Zonisamide

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Abstract

Since December 1999, 3 drugs have been cleared for marketing by the US Food and Drug Administration for the treatment of partial-onset seizures in adults with epilepsy — levetiracetam, oxcarbazepine and zonisamide. All are approved as adjunctive therapy; oxcarbazepine is also approved as monotherapy. Levetiracetam appears to have a novel mechanism of action, while the others block voltagesensitive sodium channels (oxcarbazepine and zonisamide) and T-type calcium channels (zonisamide). Levetiracetam and oxcarbazepine have short serum elimination half-lives and can be started at therapeutic dosages. All 3 drugs exhibit linear pharmacokinetics and have a low propensity for drug-drug interactions. There is extensive worldwide experience with oxcarbazepine and zonisamide, whereas exposure to levetiracetam has been limited to a relatively small number of patients in clinical trials.

These 3 drugs are important additions to the armamentarium for the treatment of seizures and offer patients whose lives are compromised by epilepsy the potential to achieve a better quality of life.

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Notes

  1. 1Because the use of felbamate is associated with amarked increase in the incidence of aplastic anaemia and the occurrence of fatal hepatic failure, it should only be used in patients whose epilepsy is so severe that the risks of aplastic anaemia and liver failure are outweighed by the potential benefits of seizure control.

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  1. Departments of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, K-478, Boston, Massachusetts, 02215, USA

    Steven C. Schachter

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Schachter, S.C. The Next Wave of Anticonvulsants. Mol Diag Ther 14, 229–249 (2000). https://doi.org/10.2165/00023210-200014030-00005

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