Treatment of epilepsy in the new millennium

Treatment options for epilepsy have increased markedly since 1990, when only carbamazepine, phenytoin, phenobarbital, primidone, and valproate were used commonly for partial and secondarily generalized seizures. Those with primary generalized seizures received ethosuximide or valproate. Over the past decade, however, additional agents have been introduced, with the promise of improved seizure control and minimal side effects. The new antiepileptic drugs (AEDs)-felbamate, gabapentin, lamotrigine, tiagabine, topiramate, vigabatrin and oxcarbazepine-have demonstrated superior efficacy for some with refractory epilepsy. In addition, the new agents frequently are better tolerated when used as monotherapy or adjunctive therapy. The optimal place for the new AED will require additional studies and careful postmarketing surveillance and assessments. Although these AEDs offer benefits, not all patients with epilepsy have responded. Thus, the search for new AEDs continues.