Use and misuse of new antiepileptic drugs

Abstract

The term ‘old antiepileptic drugs (AEDs)’ refers to antiseizure medications marketed prior to 1970. Starting with 1989, a large number of ‘new AEDs’ have been introduced gradually into routine clinical pratice and some of these medications are now considered to be valuable options for first-line treatment. The golden rule governing AED therapy consists in tailoring the choice of the drug to the characteristics of the individual. In that regard, the key question is not whether to use an old- or a new-generation AED, but which medication represents the most appropriate choice taking into account the person’s seizure type(s), epilepsy syndrome (including etiology), age, gender, comorbidities, concomitant treatments and other risk factors for adverse drug reactions. Cost considerations are also important, particularly in low-income countries. In general, new medications are not more efficacious than older generations agents. Although some of the newer AEDs are associated with a lower risk of adverse effects (including teratogenicity) and cause fewer adverse drug interactions compared with older agents, the advantages of newer medications are often overstimated, mainly as a result of drug promotion in the marketplace. This presentation will highlight situations where the choice of a new medication is preferable, as well as scenarios where new medications are clearly misused.