Einsatz neuer antiepileptika bei vorher unbehandelten jugendlichen und erwachsenen mit epilepsie: Therapie-empfehlungen

New antiepileptic drugs (AEDs) for therapy of previously untreated adolescents and adults with epilepsy in Germany are gabapentin (GBP), lamotrigine (LTG), oxcarbazepine (OXC), and topiramate (TPM). They have a number of advantages compared to old AEDs such as carbamazepine (CBZ), phenobarbital (PHB), phenytoin (PHT), primidone (PRM), and valproate (VPA). The new AEDs show similar efficaciousness and at least similar or better tolerability at adequate dosages than old drugs for patients with partial epilepsy because they are less or not enzyme inducing at all and thus cause fewer drug interactions and are less likely to produce hormonal-metabolic disturbances. Based on current evidence, the major malformation rate associated with the use of LTG is similar to that seen during CBZ treatment or in untreated women with epilepsy and is lower than that observed with VPA treatment. These data request that a careful evaluation is needed to determine if a new AED should be preferred over an old AED when starting an AED in a previously untreated patient with epilepsy. The choice among the new AEDs will be made after careful consideration of all other individual relevant factors. In patients, in whom adverse events of the old AEDs could be particulary harmful, suitable new AEDs which are less or not at all enzyme inducing, should be preferred.