Dose issues in antiepileptic therapy

Antiepileptic drug (AED) therapy is complex, with numerous traditional drugs and more than 10 second-generation drugs being approved since the mid-1990s. The burden of epilepsy is compounded by the adverse effects of these drugs, which comprise a variety of manifestations, the most devastating of which is their association with physical and cognitive foetal malformations in babies exposed to these agents in utero. Many effects are dose-related - a clear understanding of these adverse effects is desirable to be able to adjust medications and medication regimens to suit individual patient needs and to try to prevent them, by a careful introduction, slow escalation, well-considered combination and possible pre-exposure testing of patients for their tolerance, to each proposed AED. The overall problem and the profiles of the main agents are outlined from the perspective of dose-related issues.