Newer Therapies in the Drug Treatment of Epilepsy

Abstract

OBJECTIVE: To provide a review of recent developments in the pharmacotherapy of epilepsy. DATA SOURCES: A MEDLINE search was performed to identify pertinent literature (1966–June 2001). Selected articles emphasized those published from 1997 to 2001. Bibliographies of identified articles were also evaluated. STUDY SELECTION AND DATA EXTRACTION: All identifiable sources written in English. DATA SYNTHESIS: Epilepsy is a common neurologic disorder, and antiepileptic drugs (AEDs) are the mainstays of therapy. The focus of this article is on the 3 latest AEDs — Levetiracetam, oxcarbazepine, and zonisamide. We discuss human data published as both original studies and reviews from the last 4 years, except where noted. We apply a general template for all 3 drugs and provide information on clinical trials, adverse effects, pharmacokinetics, drug interactions, and clinical use. CONCLUSIONS: Levetiracetam, oxcarbazepine, and zonisamide are reasonable options for many patients whose seizures are not yet controlled or who suffer from intolerable adverse effects. All 3 agents are approved for adjunctive use in patients with partial seizures. Oxcarbazepine also has approval for monotherapy in partial seizures. All 3 drugs are well tolerated by most patients and have characteristics that potentially make them easier to use with medications other than the older AEDs. Further clinical experience is needed before specific recommendations can be given for their place among older and newer AEDs.