[Pharmacology in epilepsy. Where are we heading for?]

The aim of this study was to conduct a critical evaluation of the contribution made by the latest antiepileptic drugs (AED) and to describe the pharmacological therapeutic strategies, which do not contemplate the use of traditional AED, employed to treat pharmacoresistant patients.

After comparing the mechanisms of action, as well as the pharmacokinetic and pharmacodynamic characteristics of the classical and new AED, and examining the advantages and disadvantages of each of them, it still turns out to be impossible to achieve a total control of seizures in 20-25% of cases. This is due to the polymorphisms of the enzymes and of their inducers, to the over-expression of the carrier proteins (PGP, MRP) and to polymorphisms undergone by the receptors.

Although there is a need for new AED to be synthesized which can be used to attempt to reduce the rate of pharmacoresistant patients, other strategies must also be developed in the field of pharmacogenomics, and more specifically with regard to AED that are not carried by PGP or MRP. Another important area is that of substances that antagonize these carriers and, thus, allow AED to reach the site where they are to act.