Significant progress in the classification, diagnosis, and pharmacologic management of epileptic
seizures has occurred over the past two decades, but
epilepsy remains a therapeutic challenge. Clinical studies show that most patients with
epilepsy can have complete or almost complete seizure control with optimally managed monotherapy that employs a traditional
antiepileptic drug (AED). About half of the remaining patients can obtain improved seizure control with combination
antiepileptic drug therapy, but usually with more adverse effects. In the other half,
seizures remain refractory to treatment with available
antiepileptic drugs, or treatment remains problematic because of
drug intolerance. Advances in understanding the pathogenesis of
epilepsy and the mechanisms of action of
antiepileptic drugs have provided a basis for the development of new AEDs that hold promise for difficult-to-treat patients. In this decade, a number of new AEDs that may overcome some of the disadvantages of traditional AEDs and offer clinicians and patients added therapeutic options will become clinically available. These will be more fully evaluated for their clinical potential to meet existing challenges of
epilepsy treatment.