Pharmacologic management of epilepsy: an update

A fifteen-year hiatus separated the availability of established AEDs and the new AEDs, after which the 1990s brought four new AEDs on the market. The new AEDs offer many alternatives that were unavailable before this decade for people with refractory epilepsy. Because AED clinical trials are usually based on efficacy in refractory patients, new drugs have an indication only for adjunctive therapy in people with poorly controlled seizures. In spite of their indication as adjunctive therapy, the new AEDs may eventually prove to be useful in monotherapy and even initial therapy of partial and secondarily generalized seizures. Although none of the new AEDs met all the criteria of an ideal AED, namely high oral bioavailability, rapid absorption, linear kinetics, negligible protein binding, long half life, renal excretion and low potential for drug interactions, they represent significant advances over the established AEDs. The only major barrier to broader use of the new AEDs appears to be cost.