D. Janz - Böcker

Epileptic disorders need treatment for many years or even for life, and this makes a thorough understanding of the pharmacokinetics and possible hazards and side effects of the drugs used in treatment mandatory. During recent decades our knowledge in this field has considerably increased, not least as a result of the development of specific and sensitive methods for the determination of anti­ epileptic agents in biological material. The clinical pharmacology of this group of drugs has been studied extensively and can today be regarded as well established. This does not necessarily mean that drug treatment of epilepsy is without problems. For example, it has recently been shown that one of the newer anti­ epileptic drugs, greeted with great enthusiasm by clinicians, may in rare instances induce serious damage to the liver and the pancreas, and seems even to have a certain teratogenic potential. Clinical problems should be understood as a challenge to the experimental pharmacologist, who should try to find explanations for the clinical hazards, and, if possible, show new ways in which better drugs might be developed. In recent years interest has focused on the importance of the inhibitory transmitter 'l'-aminobutyric acid (GABA) in the pathophysiology of epilepsy, and there have been a series of attempts to find useful antiepileptic drugs among substances interfering with GABA metabolism in the CNS.

"He who is faithfully analysing ... epi­ lepsy is doing far more than studying epilepsy" Hughlings Jackson Modifying this well-known statement by Jackson, one could say today: "He who is faithfully analysing anti-epileptic drugs is doing far more than studying anti-epileptic drugs". For these drugs not only serve to prevent epileptic fits and thus advance the treatment of epilepsy, they are also effective in the treatment of cardiac arrhythmias and trigeminal neuralgia. Furthermore, clinical pharmacologists consider anti-epi­ leptic drugs as model drugs in pharmacokinetics and pharmocodynamics, since reliable methods are available for their determination and their effects and side­ effects can be defined. The methods of estimating of drugs in body fluids provide a tool that enables us to throw light on many obscure relationships in pharmaceutical treatment. Now that we can study the pharmacokinetics and interaction of drugs in man, many hypotheses based on clinical experience alone may well be eliminated or corroborated. The grow­ ing body of knowledge will make us more careful about the administration of drugs in combination. Now that we can study how biological parameters interfere with drug action, we may perhaps proceed to the scientific analysis of many clinical observations that suggest the importance of such factors as age, sex, menstrual cycle, pregnancy, fever, diet, stress, sport, climate, and altitude.