Resumen
Los nuevos antiepilépticos tienen ventajas potenciales como diferentes mecanismos de acción, menos interacciones medicamentosas, mejor rango terapéutico, menos efectos secundarios, mejor farmacocinética y en la mayoría no hay necesidad de monitoria de niveles séricos. Se revisa el uso en pediatría de las nuevas medicaciones antiepilépticas con énfasis en su indicación como monoterapia. Actualmente el uso del felbamato está reducido a casos refractarios de síndrome de Lennox-Gastaut; sus efectos secundarios prominentes son gastrointestinales con anorexia y pérdida de peso. El felbamato ha probado su eficacia en epilepsias refractarias. El gabapentín tiene utilidad en el tratamiento de crisis parciales, en epilepsia rolándica benigna y otros síndromes benignos, se puede utilizar con incrementos de 10 mg/k/día hasta un máximo de 80-100 mg/k/día. Los efectos secundarios incluyen agitación, letargia, sedación, síntomas gástricos, anorexia, insomnio, ataxia, temblor, mareo y ganancia de peso. La lamotrigina se ha utilizado para múltiples tipos de crisis y síndromes epilépticos. Ha sido eficaz en crisis parciales, generalizadas, tónicas, tónico-clónicas y atónicas. También es efectiva en pacientes con crisis de ausencia y otros síndromes como el Lennox-Gastaut y los espasmos infantiles. El topiramato se ha sido utilizado como medicamento de amplio espectro en mono y politerapia en crisis parciales, parciales con generalización secundaria, generalizadas, espasmos infantiles y síndrome de Lennox-Gastau. La zonisamida se ha utilizado como una medicación de amplio espectro en crisis parciales, generalizadas e inclusive espasmos infantiles. La zonisamida parece tener especial utilidad en epilepsia mioclónica juvenil donde puede controlar los tres tipos de crisis: mioclónicas, tónico-clónicas y ausencias. El levetiracetam ha sido utilizado tradicionalmente para el tratamiento de crisis parciales y secundariamente generalizadas. Analizando los datos existentes nos damos cuenta que hay una escasez de estudios prospectivos pediátricos que evalúen la eficacia y tolerancia de nuevas medicaciones antiepilépticas en monoterapia.
Citas
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