The use of anticonvulsants in neurological conditions other than epilepsy - A review of the evidence from randomised controlled trials

Anticonvulsant drugs are used in several neurological conditions in addition to epilepsy, However, only trigeminal neuralgia, diabetic neuropathy, migraine and essential tremor seem to benefit from treatment with selected anticonvulsants and other drug classes, Carbamazepine is the treatment of choice for trigeminal neuralgia, Painful diabetic neuropathy can be relieved by phenytoin and carbamazepine, while valproic acid (sodium valproate) seems effective for migraine prophylaxis, Primidone can be considered a valuable alternative for the treatment of patients with essential tremor, Although anticonvulsants appear to hold promise in other neurological illnesses (neuropathic pain, spasticity, myotonia), their efficacy in these conditions requires confirmation through large phase III trials, Evidence of the efficacy of anticonvulsants in other nonepileptic neurological clinical conditions is inadequate, and most randomised clinical trials were too small to detect a true difference between treatments. Carbamazepine, valproic acid, benzodiazepines, phenytoin, barbiturates, gabapentin and vigabatrin are, in decreasing order of preference, the most effective drugs for several of these conditions; however, treatment differences may largely reflect the intensity of use of each compound. Finally, the toxicological profile of anticonvulsants must always be considered and a decision on their use in randomised clinical trials and clinical practice should only be made after careful assessment of their risk/benefit ratio.