[Therapeutic strategy in epileptic patients]

Choosing an antiepileptic drug is crucial because it will be usually taken for many years by the patient. The development of several new drugs makes drug selection more complicated and challenging, but may be a better adaptation to the individual patient's characteristics is now easier. The main criterion of choice is the use of the international classification of the epileptic syndrome (generalised or partial) because some antiepileptic drugs may have a deleterious effect on some epileptic syndromes. Compared efficacy is not a good criterion as when the international classification is correctly used, the efficacy of the old and new medications seems to be not significantly different. The newer drugs may be better tolerated, have fewer drug interactions, and seem to affect cognitive functions to a lesser extent than old drugs, but data on the new drugs are more limited than for older ones. The choice is then guided by the individual appreciation of the risk-benefit ratio in each patient. There are special situations and populations where special recommendations can be done, and a new antiepileptic drug seems to be the better first line drug (West syndrome with tuberous sclerosis, women of childbearing potential; elderly population). The arrival of the new antiepileptic drugs makes possible a better adaptation of the treatment to the individual patient.