Phenobarbital is an anticonvulsant that has been available since 1912. It is truly the first practical anticonvulsant. For adults, the medication is overly sedating. The medication has been linked to decreased IQ in children born to mothers taking this medication. Its only advantage is that it is one time daily and extremely cheap. I do not believe this medication has any current role in epilepsy treatment in adults.

Primidone® or mysoline is an anticonvulsant that has been available since 1952. One of its breakdown products is phenobarbital. Primidone® is a useful medication for tremor. I do not belive that this medication has any role in epilepsy treatment in adults as it too is overly sedating in the doses required for epilepsy.

I have personally discontinued these medications in several patients who were not thought to be suffering from sedation. All of them became much less tired after being discontinued from the medication.

Felbamate® or Felbatol was the first of the new anticonvulsants approved in the United States. It is a broad spectrum medication with antiepileptic activity against both partial onset and generalized onset seizures. It had several drug interactions with other AEDs but this was manageable. The medication caused weight loss in many patients who took it. It was briefly withdrawn from the market when it was determined that it rarely caused aplastic anemia (inability of bone marrow to make any replacement blood cells) or liver failure resulting in death. The medication was allowed back on the market as some patients had dramatic responses to this medication. In adult epilepsy, it is hardly used due to the side effects mentioned above. I currently have exactly one patient in my practice on this medication.