Central Nervous System

Epilepsy is a heterogeneous condition requiring treatments be individualized, mainly based upon patient’s seizure syndrome and seizure type. In this, Anti-epileptic drugs (AEDs) represent a mainstay of treatment. Despite with more than 10 different AEDs be available for tailoring to aggressiveness, at least one-third of patients remain suffering from spontaneous and recurrent seizures.

Despite adequacies in AED treatments and adherence, and the emergence of newer AEDs, over 30% of patients with epilepsy remain refractory to treatment and are said to have drug-resistant epilepsy (DRE). DRE is a serious problem that can be associated with developmental delay in infants & young children, and severe disability and morbidity in older children & adults, as well as a mortality rate 5-10 times higher than the general population, due primarily to sudden unexpected death in epilepsy, accidents, suicide.

We all agree that when discussing the treatment of epilepsy, targeted populations need to be defined. Three patient groups, children, the elderly, and women, are considered “special” because of metabolic and physical differences that require particular care during treatment of this disease. Treatment options vary significantly among these populations.

In the treatment of epilepsy, the prescription of newer anti-seizure medications has markedly increased during the last decade. However, the recent findings are potentially concerning and awaiting comparative, randomized, head-to-head trial directly comparing the new drug with an old drug in the routine use.