Individualisation of therapy remains the key to successful treatment

With the introduction of felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin, and zonisamide, the number of antiepileptic drugs marketed in different parts of the world has virtually trebled between 1989 and 2002.1 The use of newer antiepileptic drugs is increasing steadily. In 2002 new antiepileptic drugs accounted for 20% of total prescriptions and for 69% of total costs for antiepileptic drugs in the United Kingdom (£99m of £142m).2 Is the shift towards new antiepileptic drugs justified, and what are the indications for these drugs in the modern treatment of epilepsy? These questions are addressed in the latest guidance from the National Institute for Clinical Excellence (NICE).2

The guidance, which is based on data from randomised trials, other published information, and feedback from professional, specialist, patient, and carer groups and drug manufacturers, focuses on the place of new antiepileptic drugs in adults. Zonisamide, not yet available in Europe, and felbamate—a last resort agent because of toxicity to bone marrow and liver—were not considered, but this does not affect the general applicability of the document. The …