Purpose of Review: Treatment of epilepsy starts with antiepileptic drug (AED) monotherapy. Knowledge of the spectrum of efficacy, clinical pharmacology, and modes of use for individual AEDs is essential for optimal treatment for epilepsy. This article addresses AEDs individually, focusing on key pharmacokinetic characteristics, indications, and modes of use.
Recent Findings: Older-generation AEDs are effective but have tolerability and pharmacokinetic disadvantages. Several newer-generation AEDs have undergone comparative trials demonstrating efficacy equal to and tolerability at least equal to or better than older AEDs as first-line therapy. The list includes lamotrigine, oxcarbazepine, levetiracetam, topiramate, and, more recently, zonisamide. Pregabalin was found to be less effective than lamotrigine. Lacosamide, pregabalin, and eslicarbazepine have undergone successful trials of conversion to monotherapy. Other newer-generation AEDs with a variety of mechanisms of action are suitable for adjunctive therapy. Rational AED combinations should avoid AEDs with unfavorable pharmacokinetic interactions or pharmacodynamic interactions related to mechanism of action.
Summary: Knowledge of AED pharmacokinetics, efficacy, and tolerability profiles facilitates the choice of appropriate AED therapy for patients with epilepsy.
Address correspondence to Dr Bassel W. Abou-Khalil, Vanderbilt University, A-0118 Medical Center North, Neurology Department, Nashville, TN 37232, Bassel.firstname.lastname@example.org.
Relationship Disclosure: Dr Abou-Khalil has served on the editorial boards of Clinical Neurophysiology and Epilepsy Research and received royalties from Elsevier Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Abou-Khalil discusses the unlabeled/investigational use of primidone for the treatment of essential tremor, valproate for the treatment of generalized myoclonic and generalized tonic-clonic seizures, gabapentin for the treatment of headache and sleep disorders, lamotrigine as a first-line treatment for epilepsy, and zonisamide as initial monotherapy for epilepsy.