Felbamate as a therapeutic alternative to drug-resistant genetic generalized epilepsy: a systematic review and meta-analysis

Abstract Introduction The effect of felbamate (FBM) on genetic generalized epilepsy (GGE) remains largely unknown. The utilization of FBM has been limited due to its potential risk of aplastic anemia and hepatic failure. This study aimed to comprehensively evaluate the efficacy and safety of FBM in the treatment of drug-resistant GGE. Methods We searched the databases, including PubMed, Web of Science, Embase, and Google Scholar, to identify cases of GGE treated with FBM. Data on outcomes and adverse events were extracted from these studies. Results The literature search yielded 9 studies with 166 cases in which FBM was used as an adjunct therapy to treat drug-resistant GGE. The pooled responder rate to FBM was 65% (95% confidence interval CI, 51–80). 17% (95% CI, 3–31) achieved seizure freedom. 81% (95% CI, 60–100) of patients with Epilepsy with myoclonic atonic seizures were responders. Adverse events were reported in 40% (95% CI, 26–54) of patients. Conclusions Patients with drug-resistant GGE achieved good responses to FBM. The high heterogeneity between studies calls for further research with large-scale, randomized controlled trials. Given the rare reports of idiosyncratic reactions of aplastic anemia and hepatic failure, intense laboratory monitoring and a slower titration schedule are recommended.