Evaluating the New Antiepileptic Drugs: Balancing Benefits and Adverse Effects

Abstract

Eight new antiepileptic drugs (AEDs) have been introduced since 1993 and clinicians are now faced with a complex array of treatment choices. In evaluating the newly available drugs, it is important to analyze the different aspects of these agents. Some of the more important characteristics to be aware of are efficacy, adverse effects, pharmacokinetics, and mechanisms of action.

One of the factors complicating treatment choice is the absence of comparative head-to-head clinical trials between the new AEDs. While in some cases it is possible to draw conclusions from the results of randomized, controlled trials that have tested medications against placebo or older drugs, often physicians have to rely on open-label data or personal experiences in selecting the right medications for specific cases.

Trends suggest that the new AEDs are more efficacious compared to the older AEDs, but the major potential benefits of the new drugs are their better safety, tolerability, and cognitive profiles and more desirable pharmacokinetics.

It is obvious that there is a need to redefine the concept of “successful” treatment of epilepsy. Patients need to be individually evaluated and, in addition to controlling seizures, tolerability should be taken into consideration in finding the most appropriate treatment regimen.