Affiliations: Department of Pediatrics/Neonatology University of
Rochester, Rochester, NY, USA | Department of Neurology, Children's Hospital Medical
Center of Akron, Akron, Ohio, USA
Abstract: Felbamate, a non-selective anticonvulsant thought to act via
blocking the N-methyl-D-aspartate receptor, has been shown in animal studies
not only to block seizures, but also to be neuroprotective. Excessive discharge
of the excitatory pathways, involving primarily the glutamate receptor system,
is important in the cascade of neuronal injury in hypoxic ischemic
encephalopathy (HIE). Because of renewed interest in adjunctive therapy in
addition to hypothermia to minimize hypoxic ischemic injury in neonates, we
report the absorption and time to peak level of felbamate preliminary to
testing its neuroprotective effects in this population. A single dose of either
45 mg/kg or 200 mg/kg of felbamate was given via nasogastric tube to four
infants with severe HIE. We measured serum felbamate levels at 2, 4, 8, 12 and
24 hours after administration of the drug. Oral absorption of felbamate is
slow. Peak levels of 40–64 μg/mL were achieved at 12 to
24 hours in the two infants who received 200 mg/kg dose. In conclusion, oral
felbamate is unsuitable for infants with HIE as oral doses are unlikely to
reach adequate neuroprotective levels in a timely fashion.
