Current challenges in the treatment of epilepsy

Significant progress in the classification, diagnosis, and pharmacologic management of epileptic seizures has occurred over the past two decades, but epilepsy remains a therapeutic challenge. Clinical studies show that most patients with epilepsy can have complete or almost complete seizure control with optimally managed monotherapy that employs a traditional antiepileptic drug (AED). About half of the remaining patients can obtain improved seizure control with combination antiepileptic drug therapy, but usually with more adverse effects. In the other half, seizures remain refractory to treatment with available antiepileptic drugs, or treatment remains problematic because of drug intolerance. Advances in understanding the pathogenesis of epilepsy and the mechanisms of action of antiepileptic drugs have provided a basis for the development of new AEDs that hold promise for difficult-to-treat patients. In this decade, a number of new AEDs that may overcome some of the disadvantages of traditional AEDs and offer clinicians and patients added therapeutic options will become clinically available. These will be more fully evaluated for their clinical potential to meet existing challenges of epilepsy treatment.