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Use of Second-Generation Antiepileptic Drugs in the Pediatric Population

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Abstract

Epilepsy is common in the pediatric population. Nine second-generation antiepileptic drugs have been approved in the US for use in epilepsy over the past 15 years: felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide, and pregabalin. Their use in pediatric patients is fairly widespread, despite most of these agents not having US FDA indications for use.

Felbamate and gabapentin were the first two second-generation antiepileptic drugs to be approved in the US. Felbamate use has been limited because of the occurrence of hepatotoxicity and aplastic anemia. Although gabapentin is a fairly well tolerated antiepileptic drug, its use has also been limited as a result of inconsistent efficacy and concern about seizure exacerbation. Lamotrigine and topiramate are broad-spectrum antiepileptic drugs with efficacy in a wide variety of seizure types. Both agents have some tolerability concerns: rash with lamotrigine and neuropsychiatric events with topiramate. There are very little data on tiagabine use in children, but this agent appears to be effective and to have a good tolerability profile. Levetiracetam is a second-generation antiepileptic agent that is available intravenously. Considering its good efficacy, fast onset of action, and low incidence of serious adverse effects, its use in the acute setting could potentially increase. Oxcarbazepine and zonisamide have been relatively well studied in pediatric seizure patients, including use as monotherapy. Both agents have demonstrated good efficacy and tolerability for patients as young as 1 month old. Vigabatrin and rufinamide are currently not available in the US, but have been shown to have some success in other countries. Pregabalin is the newest antiepileptic agent, but lacks pediatric data currently.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

No source of funding was provided for performing this review. Drs Chung and Eiland do not have any conflicts of interest. The authors thank Wesley Lindsey, David Mann, and Bernie Olin for their patience and assistance.

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  1. Harrison School of Pharmacy, Pharmacy Practice, Auburn University, Auburn, Alabama, USA

    Allison M. Chung & Lea S. Eiland

  2. Department of Pediatrics, University of South Alabama, School of Medicine, 1504 Springhill Ave, Rm 5225, Mobile, Alabama, 36604, USA

    Allison M. Chung

  3. Division of Pediatrics, University of Alabama at Birmingham, School of Medicine, Huntsville Regional Medical Campus, Huntsville, Alabama, USA

    Lea S. Eiland

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Correspondence to Allison M. Chung.

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Chung, A.M., Eiland, L.S. Use of Second-Generation Antiepileptic Drugs in the Pediatric Population. Pediatr-Drugs 10, 217–254 (2008). https://doi.org/10.2165/00148581-200810040-00003

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