Drug treatment of epilepsy: Options and limitations

The modern antiepileptic drug (AED) era—spanning a period of more than 150 years from the first use of bromide in 1857 to 2008—has seen the introduction into clinical practice of a diverse group of effective and safe drugs. These AEDs have provided considerable benefits for those afflicted with epilepsy of all kinds. In as many as 60–70% of newly treated patients, current AEDs lead to satisfactory control of seizures and a favorable risk–benefit balance for the great majority of patients, albeit with considerable differences in response depending on the type of seizure and epilepsy syndrome and rare serious adverse events. Unfortunately, in 20–30% of patients, epilepsy cannot be controlled. Patients with drug-resistant epilepsy often have serious comorbidity, including injury, depression, anxiety, and increased mortality. The aim of antiepileptic treatment should be to control seizures as quickly as possible with no or minimal side effects and with no negative impact on the quality of life. Improved seizure control is likely to reduce the morbidity and increased mortality associated with uncontrolled epilepsy. In this short overview, the options and the limitations of treating patients with epilepsy are briefly summarized.