• A Biraben, B De Toffol, F Semah, and T Rouaud.
• CHU de Rennes, service de Neurologie, Hôpital Pontchaillou, Rennes. arnaud.biraben@univ-rennes1.fr
• Rev Neurol France. 2007 Apr 1; 163 (4): 455-61.

IntroductionThe use of generic substitution for antiepileptic drugs is more and more frequent but remains controversial.Purpose And MethodsThis survey aimed to assess physicians' feelings towards effectiveness, tolerability and clinical impact of generic substitution of antiepileptic drugs on their patients. A questionnaire was sent to all French private neurologists and hospital specialists in epilepsy. Their responses were recorded from December 2005 to March 2006.ResultsA total of 312 neurologists responded. A few prescribed generic antiepileptic drugs; but a few as well indicated not to switch their prescription. Most of them felt discomfort by generic substitution. One third reported breakthrough seizures or new adverse events after generic substitution and 70p.cent extra phone consultation.DiscussionNeurologists' reluctance with prescribing generic AEDs may be explained by several different facts: no controlled study about the safety and efficacy of generic AEDs as compared with brand name drugs, substitutions by pharmacists without their agreement, lack of medical information about generic AEDs, symbolic dimension of the treatment, and, most of all, the fear of breakthrough seizures in patients good controlled.ConclusionA prospective controlled evaluation of the safety and efficacy of generic substitution in epilepsy needs to be performed.

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