Medical management of epilepsy in adults

Optimal treatment of epilepsy in adults requires a tailored approach that weighs the efficacy of individual drugs in the specific diagnosis against the patient's risks for adverse events. Partial seizures, which are the most common seizure type in adults, can be effectively controlled by virtually all the standard and newer antiepileptic drugs (AEDs). For the generalized epilepsies, valproate remains the drug of choice. Data continue to accumulate regarding use of the newer agents. Overall, many of the newer AEDs may offer a better tolerability than the standard agents because of more favorable pharmacokinetic characteristics and lack of interactions with drugs other than AEDs. Serious adverse events have been associated with felbamate and lamotrigine, however, and more experience is needed with many of the other newer AEDs to better define their safety profiles. Monotherapy should be the goal when AED treatment is instituted for the adult with epilepsy. Dosage modification on the basis of seizure control and toxicity should be implemented, as well as single-drug trials with alternative AEDs, before resorting to polytherapy. With the introduction of several promising newer AEDs, safe and effective seizure control may become a reality for an increasing number of adults with epilepsy.