Intended for healthcare professionals

Clinical Review State of the Art

Drug treatment of epilepsy in adults

BMJ 2014; 348 doi: (Published 28 February 2014) Cite this as: BMJ 2014;348:g254
  1. Dieter Schmidt, head, Epilepsy Research Group1,
  2. Steven C Schachter, chief academic officer, Consortia for Improving Medicine with Innovation and Technology 2
  1. 1Epilepsy Research Group, Goethestr. 5, 14163 Berlin, Germany
  2. 2Departments of Neurology, Beth Israel Deaconess Medical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  1. Correspondence to: D Schmidt dbschmidt{at}


Epilepsy is a serious, potentially life shortening brain disorder, the symptoms of which can be successfully treated in most patients with one or more antiepileptic drug. About two in three adults with new onset epilepsy will achieve lasting seizure remission on or off these drugs, although around half will experience mild to moderately severe adverse effects. Patients with epilepsy, especially the 20-30% whose seizures are not fully controlled with available drugs (drug resistant epilepsy), have a significantly increased risk of death, as well as psychiatric and somatic comorbidities, and adverse effects from antiepileptic drugs. Newer drugs have brought more treatment options, and some such as levetiracetam cause fewer drug interactions and less hypersensitivity than older ones. However, they do not reduce the prevalence of drug resistant epilepsy or prevent the development of epilepsy in patients at high risk, such as those with a traumatic brain injury. The development of antiepileptic drugs urgently needs to be revitalized so that we can discover more effective antiseizure drugs for the treatment of drug resistant epilepsy, including catastrophic forms. Antiepileptogenic agents to prevent epilepsy before the first seizure in at risk patients and disease modifying agents to control ongoing severe epilepsy associated with progressive underlying disease are also needed.


  • Contributors: DS wrote an early version of most sections of the manuscript and revised the manuscript. SCS edited early and revised versions of the manuscript, contributed as author to sections of the manuscript, and is guarantor.

  • Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: DS has received hospitality and consulting fees in the past two years from Eisai, Sun, UCB, and Viropharma. None of the companies has had any input to the manuscript. SCS: none declared.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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