Advances in the treatment of epilepsy: Does mechanism of action matter?

Abstract

Over the past 20 years, a number of new antiepileptic drugs (AEDs) have been introduced into the global market. While most of these newer drugs are molecularly distinct, some may more rightfully be considered analogs or subtle derivatives of existing agents. In many cases, this modification to existing drugs does not result in significantly different efficacy, but may afford improved tolerance and medication adherence. In some cases, however, improved pharmacokinetic profiles may have the additional benefit of improved anti–seizure properties as well. During this same time period, we have also seen major advances in our understanding of the neurophysiological basis for epilepsy, as well as the discovery of new molecular targets for AEDs. The objective of this lecture will be to review the basic neuropharmacological basis for the pharmacotherapy of focal seizures, as well as to discuss the recent additions to our therapeutic armentarium including lacosamide, eslicarbazepine, breveracetam and perampanel. Specifically, this lecture will address the following questions. First, is it still reasonable to still classify AEDs by “drug class” second is “new” the same as novel, and finally, is there a true basis for “rational polytherapy”.