[Therapeutic strategy in epileptic patients].

Choosing an antiepileptic drug is crucial because it will be usually taken for many years by the patient. The development of several new drugs makes drug selection more complicated and challenging, but may be a better adaptation to the individual patient's characteristics is now easier. The main criterion of choice is the use of the international classification of the epileptic syndrome (generalised or partial) because some antiepileptic drugs may have a deleterious effect on some epileptic syndromes.

Drug induced encephalopathy in six epileptic patients: topiramate? valproate? or both?

Six severe epileptic patients developed stuporous encephalopathy with marked cognitive impairment when topiramate (TPM) and sodium valproate (VPA) were coprescribed for five patients, and when monotherapy with TPM was introduced for one patient. In four patients, ammonaemia increased and then returned to normal after TPM or VPA withdrawal. This severe potential side effect must be recognized.