When introduced in 1993, felbamate (FBM) was greeted with great enthusiasm. It was particularly welcome for its potential contribution to the treatment of refractory epilepsy syndromes in patients with developmental disabilities, including Lennox-Gastaut syndrome. Subsequent discoveries about its association with fatal hepatitis and aplastic anemia have restricted its use greatly. FBM may re-emerge as an important tool in the treatment of refractory epilepsy syndromes if better methods of predicting which patients are at risk for these complications are discovered.

Anecdotal experience with FBM suggests that it has stimulant-like properties that may be experienced favorably or unfavorably by patients. Some patients have experienced increased alertness, improved attention, and enhanced concentration abilities (in contrast to the commonly encountered sedation associated with other AEDs). Others have reported anorexia, insomnia, and anxiety.111–113 Numerous reports of mania, psychosis, and behavioral disturbances also have been noted.114,115

Adapted from: Ettinger AB, Barr WB, and Solomon SP. Psychotropic properties of antiepileptic drugs in patients with developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;219–230. With permission from Elsevier (www.elsevier.com).

Authored By: 
Sanford P. Solomon MD
William B. Barr MD
Alan B. Ettinger MD
Reviewed By: 
Steven C. Schachter MD
Thursday, April 1, 2004