[Therapeutic arsenal in adult epilepsy]

Over the last 20 years, the number of drugs licensed for the treatment of seizure disorders has increased exponentially. Although the second-generation antiepileptic drugs have failed to significantly reduce the proportion of drug-resistant patients, their safety profile and the reduction of drug to drug interactions now allow to better tailor the treatment to each patient. The decision to initiate an antiepileptic drug in newly diagnosed epilepsy relies on a careful assessment of the expected benefit according both to the risk of seizure recurrence and to the risk of drug-related adverse events. In patients in whom a treatment is initiated, the final choice of the drug must then take into account both the expected efficacy of the drug and its relevance to the specific characteristics of the patient, including his/her gender, age or comorbidities. This approach is essential in all patients, with a special attention to the issues raised in women of childbearing age.