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The new antiepileptic drugs
  1. S Macleod,
  2. R E Appleton
  1. Roald Dahl EEG Department, Paediatric Neurosciences Foundation, Royal Liverpool Children’s Hospital (Alder Hey), Liverpool, UK
  1. Dr R E Appleton, Roald Dahl EEG Department, Paediatric Neurosciences Foundation, Royal Liverpool Children’s Hospital (Alder Hey), Liverpool L12 2AP, UK; richard.appleton{at}rlc.nhs.uk

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The aim of this review is to describe the properties and uses of the more recently available anticonvulsant agents. The goal of epilepsy treatment is to achieve total seizure freedom with no side effects. Despite the appropriate use of anticonvulsants approximately 25% of children will continue to experience seizures. The development of new anticonvulsants is therefore imperative. Since the late 1980s there have been a number of new anticonvulsant agents with various modes of action and differing applications in clinical practice. Although this potentially increases the therapeutic options available to clinicians, the increased choice of drugs may also lead to irrational polypharmacy and some agents are recognised to increase seizures in certain epilepsy syndromes.

INTRODUCTION

Epilepsy is a common problem in childhood with an annual incidence of 60/100 000 children.1 The goal of epilepsy treatment is to achieve complete seizure freedom without any adverse side effects. When considering all the childhood epilepsies, approximately 25–30% of children will continue to experience seizures that are resistant to all currently available antiepileptic drugs. The term “antiepileptic” is somewhat of a misnomer because all that the current antiepileptic therapies are able to achieve—with the exception of epilepsy surgery—is to prevent seizures in someone who has epilepsy. Most but not all of these drugs are effective against tonic-clonic convulsions, which is why antiepileptic drugs may also be called “anticonvulsants”. The antiepileptic drugs that are currently available have no effect on the underlying cause of the seizures. Given the current limitations of therapy, it remains important to try and identify new drugs which are not only effective in preventing seizures and are safe, but which may also be able to act directly on the underlying cause of the epilepsy, or at least modify the pathogenesis of the seizures.

Modern epilepsy treatment began in 1857 with the introduction …

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