Medical treatment of epilepsy

The licensing of new antiepileptic drugs (AEDs) has led to a marked increase in the pharmaceutical armamentarium available for the treatment of epilepsy since 1990. The new drugs have now secured their place in the pharmacotherapy of epilepsy. The main reason for their success is their good general tolerability (especially with regard to cognitive function), the low rate of drug-drug interaction and the high anticonvulsant potency of some of the compounds. It is fortunate that many of the new AEDs have also proven effective in the treatment of generalised seizures, although they were originally developed for the treatment of focal seizures. However, the wide treatment choice has not solved the problems associated with the medical treatment of epilepsy. In monotherapy, none of the new AEDs have been shown to be superior in their potency to control seizures to older AEDs in comparative studies. Nonetheless, the greater choice of drugs allows treatment to be better tailored to the requirements of individual patients. Now there is a need to study patients whose seizures were not controlled by initial or alternative monotherapy to create an evidence-base for truly rational combination therapy in the future. Additional improvements in the medical treatment of epilepsy may come from AEDs currently in development, many of which use novel or unknown modes of action. So far, however, there is no evidence that any of these compounds will have radically different effects from the drugs currently available, or that they will have antiepileptic rather than purely anticonvulsant potential.