Strategies of using the new antiepileptic drugs for epilepsy in adults

Abstract

The new antiepileptic drugs have not changed the basic pharmacological treatment principles of epilepsy, but they have given greater choice in focal and in generalized epilepsies as well. The new drugs are not necessarily more effective than traditional drugs, but they have favourable pharmacokinetic characteristics, fewer interactions and better adverse effect profile in the acute and chronic phase of the treatment. They generally show a lower teratogenicity risk than the standard antiepileptics, although carbamazepine, one of the standard drugs can be used and zonisamide, a new one must be avoid in pregnancy. Due to characteristics mentioned above they are not only effective as add-on therapy, but in monotherapy as well. On the basis of the international and national recommendation lamotrigine and levetiracetam belong to the first line antiepileptics. The favourable tolerability of the new antiepileptics may improve the patient's compliance and adherence to the given treatment. The low teratogenicity makes them especially suitable for the treatment of women of childbearing age. The new antiepileptic drugs can succesfully used for the treatment of special patients' groups as for the post stroke, poszttraumatic epilepsies, for the epilepsies accompanied with brain tumours as well as for epilepsies in the elderly. The new drugs are advantageous for the treatment of such patients who have psychiatric symptoms or signs of cognitive decline and high risk of these symptoms respectively.