Felbamate in intractable pediatric and young adult epilepsy

Abstract

Felbamate (FBM) use in treatment of pediatric and adult epilepsy has sharply declined since early reports of FBM- associated hematologic and hepatic injury. We retrospectively reviewed the efficacy and safety profile of FBM in children and young adults with intractable epilepsy treated with this antiepileptic drug as adjunctive therapy in our pediatric epilepsy clinic from 2001-2010. We identified 101 patients 2-22 yr (mean 12.8 ± 1.8 yr) with various seizure types and epilepsy syn- dromes. FBM dosing was titrated according to tolerability and seizure control. Mean duration of FBM treatment was 43.7 ± 30.4 mo. Patients had periodic serum drug levels, serum hematologic and metabolic panels and body-mass index measurements during treatment and follow-up. No patient had serious adverse effects, including aplastic anemia or hepatic failure. Using sub- jective seizure counts, FBM also seemed to be effective in seizure control; 22 (22%) patients were reported as seizure-free; 59 (59%) patients were said by parents to have had fewer seizures, and 20 (20%) patients were estimated as having unchanged sei- zure frequency. Weight loss, though typically mild, was the major adverse effect. In children older than 3 yr, 46 (53%) of 86 lost weight during FBM administration and 40 (47%) children gained weight. No patients required discontinuation of FBM due to adverse effects. FBM was well-tolerated and without serious adverse effects in our patients. FBM seemed to be effective in reducing seizure frequency. It should be considered a viable current option for treatment of intractable seizures in children, though weight should be monitored in these patients.