Of 51 children with intractable seizures treated for two months with add on felbamate (50-75 mg/kg/day) at the Scottish Rite Children’s Hospital, Atlanta, GA, 51% responded with improved seizure control, 22% were unchanged, and 28% had increased seizure frequency. Significant insomnia limited the usefulness of felbamate in 39% of children. Other adverse effects included anorexia, hyperactivity, and choreoathetosis. [1]

COMMENT. Clinically significant weight loss and anorexia were troublesome side effects during a trial of felbamate in 68 children and adults with intractable seizures at Rush-Presbyterian-St Luke’s Medical Center, Chicago [2]. Insomnia was reported in 25% of felbamate-treated patients in a further study of 16 patients. [3]

Gabapentin (Neurontin), another newer anticonvulsant, recently approved and introduced for treatment of partial and secondarily generalized seizures in children older than 12 years and in adults, was found to be safe and well-tolerated as monotherapy in a multicenter study [4]. Adverse effects have been minor and psychometric testing revealed no cognitive impairments. In follow-up studies > 1 year, there was no evidence of chronic toxicity. Unlike other anticonvulsants, gabapentin is not metabolized by the liver and is free of interactions with other drugs. [5]