Advances in the medical treatment of epilepsy.
Treatment options for epilepsy, especially using antiepileptic drugs, have increased substantially in the past five years. Since 1993, four novel antiepileptic drugs have been approved and marketed in the United States: felbamate, gabapentin, lamotrigine, and topiramate. Two others, tiagabine and vigabatrin, are likely to be approved in the near future. For many patients, these agents offer the realistic promise of improved seizure control, often with fewer adverse effects and less significant drug interactions compared with older agents. In addition, fosphenytoin, a water-soluble phenytoin prodrug with a number of advantages over intravenous phenytoin, has been released. There are new administration options for carbamazepine, diazepam, and valproic acid. For drug-resistant or -intolerant patients, there has been renewed interest in alternative therapies, especially the ketogenic diet. Taken together, these represent significant therapeutic advances that are benefiting patients with epilepsy. At the same time, improved understanding of the basic mechanisms of epileptogenesis, and of the cellular and molecular actions of available antiepileptic drugs, creates a framework for designing unique therapeutic strategies that are targeted at key sites of vulnerability involved in the development and maintenance of the epileptic state.
Bazil
C W
CW
Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, New York, USA.
Pedley
T A
TA
D000085:Acetates / Q000009:adverse effects / Q000627:therapeutic use; D000588:Amines; D000927:Anticonvulsants / Q000145:classification / Q000627:therapeutic use*; D002220:Carbamazepine / Q000008:administration & dosage / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids; D003975:Diazepam / Q000008:administration & dosage / Q000627:therapeutic use; D017277:Drug Approval; D015195:Drug Design; D004347:Drug Interactions; D004351:Drug Resistance; D004827:Epilepsy / Q000178:diet therapy / Q000188:drug therapy* / Q000209:etiology / Q000235:genetics / Q000473:pathology; D000078328:Felbamate; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007275:Injections, Intravenous; D007659:Ketones; D000077213:Lamotrigine; D014179:Neurotransmitter Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D009557:Nipecotic Acids / Q000009:adverse effects / Q000627:therapeutic use; D048448:Phenylcarbamates; D010672:Phenytoin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D011355:Prodrugs / Q000627:therapeutic use; D011409:Propylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D000078308:Tiagabine; D000077236:Topiramate; D014227:Triazines / Q000009:adverse effects / Q000627:therapeutic use; D014481:United States; D014635:Valproic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D020888:Vigabatrin; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D007659:Ketones; D014179:Neurotransmitter Uptake Inhibitors; D009557:Nipecotic Acids; D048448:Phenylcarbamates; D011355:Prodrugs; D011409:Propylene Glycols; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D010672:Phenytoin; D000077206:Gabapentin; C043114:fosphenytoin; D020888:Vigabatrin; D003975:Diazepam; D000077213:Lamotrigine; D000078328:Felbamate; D000078308:Tiagabine