Anticonvulsant mechanisms for today and tomorrow

Epilepsy is perhaps the most common of all the serious neurological disorders, with 50-100 million people worldwide exhibiting clinically recognized epilepsy. However, there has been relatively little improvement in anticonvulsant drug efficacy since the introduction of, for example, phenobarbital and phenytoin in 1912 and 1930. Epilepsy can be broadly subdivided into partial, generalized and unclassified seizures, and seizure type is used to guide the selection of the anticonvulsant drug to be used. If monotherapy with one anticonvulsant class fails, then an agent from a different class is attempted. If patients still prove to be refractory, combination therapy is considered. Despite side effects, approximately 60% of patients experience long-term remission of their symptoms following drug therapy, while 40% remain refractory to drug treatment, emphasizing the need to develop novel anticonvulsant mechanisms with enhanced efficacy.