Practice advisory:

  1. Patients for whom the risk-to-benefit ratio supports use because there is class I evidence for benefit:
    1. Lennox-Gastaut patients over the age of 4 years who are unresponsive to primary antiepileptic drugs (AEDs)
    2. Those patients older than 18 years of age who have intractable partial seizures and in whom the use of standard AEDs at therapeutic levels has failed (Data indicate a better risk to benefit ratio for felbamate used as monotherapy.)
    3. Patients who have been on felbamate more than 18 months
  2. Patients for whom the current risk-to-benefit assessment does not support the use of felbamate:
    1. Adults or children with new-onset epilepsy
    2. Patients who have experienced significant prior hematologically adverse events
    3. Patients in whom follow-up and compliance do not allow careful monitoring
    4. Patients unable to discuss risks to benefits (i.e., with mental retardation, developmental disability) and for whom no parent or legal guardian is available to provide consent
  3. Patients in whom the risk-to-benefit ratio is unclear and based on case reports and expert opinion (class III) only, but under certain circumstances depending on the nature and severity of the patient's seizure disorder, felbamate use may be appropriate:
    1. Children with intractable partial epilepsy
    2. Other generalized epilepsies unresponsive to primary agents
    3. Patients who experience unacceptable sedative or cognitive side effects with traditional AEDs
    4. Patients with Lennox-Gastaut syndrome younger than 4 years of age who are unresponsive to other AEDs

Based on French J, Smith M, Faught E, et al. Practice advisory: the use of felbamate in the treatment of patients with intractable epilepsy. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 1999;52:1540-1545.
Adapted by Sepkuty JP and Kaplan PW. Hematologic and pulmonary disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;209-228.
With permission from Elsevier ( || More information available at National Guideline Clearinghouse.

Authored By: 
JP Sepkuty
PW Kaplan
Reviewed By: 
Steven C. Schachter MD
Thursday, April 1, 2004