Purpose of Review: Selection of the ideal antiepileptic drug (AED) for an individual patient can be a daunting process. Choice of treatment should be based on several factors, including but not limited to epilepsy classification, AED mechanism of action, AED side-effect profile, and drug interactions. Special consideration must be given to populations such as women, older adults, patients with other medical comorbidities, and patients who are newly diagnosed.
Recent Findings: Head-to-head trials between AEDs in newly diagnosed patients rarely demonstrate that one AED is more or less effective. The second-generation drugs, lamotrigine, topiramate, oxcarbazepine, zonisamide, and levetiracetam, have undergone head-to-head trials confirming similar efficacy and equal or better tolerability than standard drugs in focal epilepsy.
Summary: A thoughtful approach to the AED selection process must factor in data from clinical AED trials as well as a variety of patient characteristics and confounding factors. When neurologists apply an individualized approach to AED drug selection for their patients, they can find an effective and well-tolerated drug for most patients.
Address correspondence to Dr Jacqueline A. French, 223 East 34th St, New York, New York 10016, Jacqueline.firstname.lastname@example.org.
Relationship Disclosure:Dr French has received research support from Cyberonics, Eisai Co, Ltd, Entra Pharmaceuticals, GlaxoSmithKline, Johnson & Johnson Services, Inc, Lundbeck, Marinus Pharmaceuticals, Inc, Neusentis, NeuroTherapeutics Pharma, Inc, NeuroVista Corporation, Ono Pharmaceutical Co, Ltd, Pfizer Inc, Sunovion Pharmaceuticals Inc, SK Life Science Inc, Supernus Pharmaceuticals, Inc, Taro Pharmaceutical Industries, Ltd, UCB, Upsher-Smith Laboratories, Inc, Valeant Pharmaceuticals International, Inc, and Vertex. Dr Gazzola reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Dr French discusses the unlabeled use of zonisamide and levetiracetam as initial monotherapy for juvenile myoclonic epilepsy. Dr Gazzola reports no disclosure.