The Role of the Old and the New Antiepileptic Drugs in Special Populations: Mental and Multiple Handicaps

Summary: Epilepsy is common in individuals who are mentally retarded and/or otherwise multiply handi capped. These patients often display several seizure types. Seizure control may be difficult and drug interac tions common because of polytherapy. Cognitive, behav ioral, affective, and motor problems in these patients of ten confound accurate diagnosis and effective manage ment. Treatment often requires not only antiepileptic drugs (AEDs) but also psychoactive drugs and/or envi ronmental and personal support. To minimize unwanted drug effects, therapeutic strategies should focus on the administration of the fewest possible drugs at the lowest effective dose. The new AEDs may be of special value at times in these populations because they offer potential for improved efficacy, but especially because many of them provide better safety profiles and fewer pharmacokinetic interactions with other drugs.