The star systems: overview and use in determining antiepileptic drug choice

An explosion in antiepileptic drug (AED) therapy began in the 1990s with the licensing of 9 new chemical entities and more to come. Important differences between AEDs may not be detected by regulatory trials, which are designed to satisfy licensing requirements and often diverge considerably from everyday clinical practice. The Star Systems have been developed as evidence-based yet pragmatic and flexible models for comparing AEDs. Each drug has been judged across a range of criteria, including mechanism of action, pharmacokinetics, ease of use, efficacy, tolerability, safety, interaction profile and a 'comfort factor'. A score has been allocated under each category and systems have been devised for patients with newly diagnosed epilepsy and those with difficult-to-control seizures requiring combination therapy. The choice of treatment should involve assessment of patient-related factors, accurate classification of seizure type and syndrome, married with an understanding of the pharmacology of the AEDs. A staged management plan should be formulated when initiating treatment with the aim of preventing the development of refractory epilepsy. When using combinations of AEDs, the mechanism of action of each agent should be taken into consideration. Such an individualised approach to management will optimise the chance of attaining remission and help many more patients achieve a fulfilling life.