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In this case, careful monitoring is needed because unpredictable interactions between antiepileptic drugs are possible. Withdrawal from antiepileptic drugs should be gradual to avoid the risk of precipitating rebound seizures. It is not known exactly how antiepileptic drugs work, but two mechanisms seem to be important for drugs in current use, while newer drugs may work by other means yet to be elucidated. Many well-established antiepileptic drugs (for example phenobarbital and benzodiaze pines) are known to facilitate the opening of GABA chloride ion channels at synapses. However, this is not the complete explanation as, for example phenobarbital is far more effective as an anticonvulsant than other barbiturates with the same enhancing effects on GABA. Newer drugs have been shown to interfere with GABA in other ways: by inhibiting GABA-transaminase, the enzyme responsible for inactivating GABA (vigabatrin and valproate) or by directly stimulating GABA receptors.

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