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INTRODUCTION: Although the significant progress in pharmacotherapy of epilepsy during last decade was achieved, about one third of patients are resistant to the current treatment. The introduction of numerous effective, well tolerated and safe new antiepileptic drugs (AEDs) in the last decade of the 20th century has widened the choice of treatment options in epilepsy and improved the tolerability and the ease of use of treating patients with epilepsy. Nevertheless, significant safety and efficacy deficits continue to exist. Severe idiosyncratic reactions and organ toxicity have hampered the wide use of some of the newer AEDs. As a decade before, about one third of patients with chronic epilepsy is resistant to current pharmacotherapy. Even in patients in whom pharmacotherapy is efficacious, current AEDs do not seem to affect the progression or the underlying natural history of epilepsy. DEVELOPMENT: The revision of newer AEDs are formulation, action, doses and side effects. CONCLUSION: Thus, there is an unmet need for safer and more effective drugs, especially for chronic, drug-resistant epilepsy. To stimulate the development of even better compounds, the demonstrated benefits and risks of current new AEDs are reviewed.

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INTRODUCTION: In some studies in children, topiramate showed efficacy. AIM: To evaluate efficacy, tolerability and safety of topiramate in monotherapy in newly diagnosed epilepsy vs carbamazepine in children. PATIENTS AND METHODS: In a multicentre, open-label, comparative and randomized study patients with partial epilepsy, were randomized to received topiramate or carbamazepine treatment. Patients with degenerative disease were excluded. Data were analysed by SPSS statistical program v. 11.0, and non parametric test. Comparisons between groups were made with chi square test and t Student's test. RESULTS: In total were included 88 patients, 33 in group 1 (topiramate), 32 group 2 (carbamazepine), 23 were drop-outs because adverse events and lost in follow-up (13 in group 1 y 10 group 2). In both groups were observed good efficacy, in month 6 and 9 of follow-up, the average of seizures in group 1 were better than group 2 (p = 0.01, t Student's test). The percentage of free seizure patients was greater in group 1 than group 2 (statistical significance p = 0.02 chi square test). The adverse events were similar in both groups and mild, somnolence 9%, weight loss 6% in group 1 and somnolence 19%, dizziness 3% and seizure discontrol 3% in group 2. CONCLUSIONS: Good efficacy in both groups, and topiramate in good treatment choice in newly diagnosed epilepsy in children because it's the efficacy and tolerability in comparison with the gold standard carbamazepine.

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DEVELOPMENT: Traditionally it has been shown that anti epileptic drugs have side effects which cause alterations particularly in behaviour and cognition, independently from that due to the epilepsy itself. This has caused great controversy. Some studies have informed that many of these drug effects are caused by the epilepsy rather than the drugs themselves. It is possible that the drugs may cause changes in behaviour and cognition, but these also improve when the seizures are brought under control. The main problem therefore is to determine the methodology which would take these variables into account, since many studies do not follow a standard methodology: the various drugs and neuropsychological aspects are compared using a large variety of tests. CONCLUSIONS: At the present time, using suitable methodology, and double blind randomized controlled trials, it has been found that the secondary effects on cognition and behaviour are not as severe as had been thought. The drug causing most alterations is phenobarbitone and some benzodiazepines, such as clonazepam, alter cognitive function to a greater degree. With the newer anti epileptic drugs improvement in cognition has been observed due to its mechanism of action and to control of the epilepsy.

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Neurological alterations are very frequent in children with end stage renal disease (ESRD). In order to assess the type of these complications, a neurological study was undertaken in 30 children with ESRD. Three of the patients had convulsions and hyperreflexia was the only clinical sign found in all the patients. Low serum levels of hemoglobin and calcium and high concentrations of phosphates, aluminum and parathyroid hormone were found in all cases, but correlations with any neurological alteration were not made. Abnormal EEG with slow waves in the occipital region were obtained in 23 patients. Sensorial hypoacusia was registered in 6 children who were previously treated with aminoglucosides. The cerebral tomography showed calcifications in three instances, but only in one patient were of clinical significance. In five, out of the 30 patients, cerebral atrophy was detected. In conclusion, assessment of the neurological condition is mandatory in children with ESRD before renal transplantation is performed, since the complication itself or the therapy may interfere with rehabilitation.

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