The irreversible GABA transaminase inhibitor vigabatrin (VGB) was given in a single-blind fashion to 89 patients with complex partial seizures (CPS) refractory to conventional drugs. The median number of CPS per month decreased from 11.0 to 5.0 after addition of VGB, and 51% of patients had a 50% or greater decrease in CPS frequency (p less than 0.001). Side effects (principally drowsiness, ataxia, and headache) occurred mainly during the initiation of therapy and decreased during therapy. After 12 weeks on VGB, side effects significantly interfered with functioning in only 13% of patients, and the efficacy:toxicity ratio warranted continued administration in 74% of patients. Coadministration of VGB resulted in a mean decrease of 20% in phenytoin serum concentration (p less than 0.001). Sixty-six patients with a favorable response to VGB during the single-blind study have been followed for a median of 16.7 months on VGB. No serious systemic or neurologic toxicity has been detected, and most patients have retained their initial favorable CPS control.

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Buspirone is an anxiolytic drug from the azapirone family of molecules. It differs chemically and pharmacologically from the benzodiazepines. Although its profile of efficacy is comparable with that of benzodiazepines, it produces less drowsiness, less psychomotor impairment, less alcohol potentiation, and has less potential for addiction or abuse. Buspirone also appears to have efficacy in major depressive disorders, in comparison with placebo, but its activity in panic disorders is less impressive. It may diminish alcohol dependence both in animals and in chronic alcoholics. Clinical studies in the elderly show no important difference from younger patients in safety and efficacy profile, pharmacokinetics, and dosage requirement. The drug appears to be well tolerated in primary care settings and to be free of adverse clinical interactions with many drugs that might be used concomitantly. However, because its pharmacology differs from that of conventional anxiolytics, patients need to be informed about both its gradual onset of action and absence of euphoria and immediate sedation.