Newly diagnosed epilepsy and pharmacogenomics research: a step in the right direction?

Pharmacogenomics holds the promise of selecting the right drug at the right dose for the right person. Its research and application in epilepsy are in their infancy. Although advances have been made in identifying genetic markers of adverse effects in terms of severe cutaneous reactions, there has been little progress in predicting efficacy. Most studies have been retrospective and case-control in design, despite the associated problems of recall bias and a usually undefined relationship between genotype and outcome. We describe the epidemiological framework necessary to detect genetic influences on antiepileptic drug response, and propose an ambitious prospective outcome study of newly diagnosed epilepsy across all age ranges, countries, and continents, which would provide the template for a global pharmacogenomic project. Other epidemiological considerations and statistical constraints and issues related to study design, databases, and ethics that are critical for advancement in the field are also discussed.