Practical clinical issues on the use of antiseizure drugs

Abstract

With the advent of new antiepileptics safer and better tolerated, the use of anti-seizure drugs in the treatment of psychiatric disorders has experienced a remarkable growth in the last decade. Since the introduction of vigabatrin, in 1992, the armoury of available anticonvulsants has increased rapidly at a rate of practically one drug every one or two years. The fast arrival to the market of such a huge number of drugs hampers the psychiatrist keeping updated, especially when taking into account that the use of new anticonvulsants to treat different psychiatric disorders is based, to a great extent, on clinical experience rather than on clinical trials and thus, no standardised posologies or guidelines for their use are available. Nevertheless, psychiatrists need to know the peculiarities of each of these drugs regarding their routine management, as well as in special situations as pregnancy or renal or hepatic insufficiency. This article gives some recommendations about practical issues on the management of these drugs, most of which are necessarily based on experience gained from epileptic patients.