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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Current treatments of epilepsy

From the Comprehensive Epilepsy Center, New York University School of Medicine, New York, New York, USA.

Address correspondence to Dr. Siddhartha Nadkarni, Comprehensive Epilepsy Center, NYU School of Medicine, 403 East 34th Street, 4th Floor, New York, NY 10016, USA; e-mail: siddhu{at}mindspring.com

Medical therapy is the mainstay for epilepsy, with most patients well controlled on a single antiepileptic drug (AED). In this non-refractory group, many patients have medication side effects and occasional seizures. Approximately 30% of patients with partial epilepsy and 25% of patients with generalized epilepsy are not well controlled on medications. These patients are often receiving multiple AEDs, with disabling seizures and side effects. Although second-generation AEDs are safer and better tolerated than the older AEDs, there are scant data to support significant advantages in efficacy. In VA studies with older AEDS, therapy with two AEDs improved seizure control in 40% of patients but seizure freedom was achieved in only 9%. A meta-analysis of the second-generation AEDs used as adjunctive therapies shows that 12% to 29% of patients had a 50% or greater reduction in seizure frequency. Surgery and the vagus nerve stimulator provide important therapeutic options in patients whose seizures are not controlled by AEDs. Special considerations about epilepsy care must be made in pediatric populations, those with developmental delays, women, and the elderly.

Publication of this supplement was made possible by an educational grant from GlaxoSmithKline. The sponsor has provided O.D. with the following financial support: honoraria during his career (in excess of $10,000), and grant support. S.N. and J.L. have disclosed no financial relationship with the sponsor.

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