Successful long-term treatment of patients with
epilepsy requires selection of an appropriate
antiepileptic regimen, optimal dosing and patient compliance. Recent advances in our understanding of the
biological basis of
epilepsy and in the choice of treatment options are transforming the global management of these patients. If the achievement of seizure freedom remains the primary goal of any
antiepileptic treatment, issues associated with
drug acceptability and tolerability, and with quality of life of patients, have gained increasing attention as major determinants of ultimate therapeutic success.
Sustained-release formulations of
antiepileptic drugs can be very helpful in achieving treatment objectives. Stable serum levels without marked peak-to-trough fluctuations, reduced frequency of dosing and the possibility of dosing flexibility may all improve compliance, patient satisfaction and ultimately quality of life. The efficacy of
sodium valproate for the treatment of most types of
epilepsy has been demonstrated extensively and this
drug remains the mainstay of treatment for many clinical situations. Among the various
valproate formulations, extended-release
tablets have shown improved patient compliance and satisfaction. However, the
tablet size and the limited dosing flexibility could be unsuitable for individualized treatment in special populations such as children, the elderly and patients with swallowing difficulties. A new
sustained-release formulation of
sodium valproate consisting of tasteless
microspheres that can be sprinkled on semi-solid food such as yoghurt or jam has been developed. A stick pack presentation allows individualized dosing and greater convenience.