[Which drugs should be chosen for the different types of epilepsy?]

Abstract

The selection of an antiepileptic drug is based primarily on its efficacy. When the efficacy of several antiepileptic drugs is similar, what is frequently observed, their safety, pharmaco-kinetics, and cost should be also considered. Efficacy, dose-dependent and idiosyncratic toxicity, pharmacokinetics features, and interactions of phenobarbital, phenytoin, carbamazepine, valproate, felbamate, gabapentin, lamotrigine and vigabatrin are comparatively analyzed, and drugs of choice for generalized epilepsies and partial epilepsies are proposed. It is concluded that phenobarbital, primidone and phenytoin are being replaced by carbamazepine and valproate as first choice drugs for most types of epilepsies due to a similar (and even better) efficacy, besides a better safety profile and easier dosing. Features of new antiepileptic drugs make they adequate to be used as add-on drugs in treatment-resistant patients: lamotrigine and felbamate are effective in Lennox-Gastaut syndrome, and vigabatrin in West syndrome, most of the new antiepileptic drugs are well tolerated and show less interactions than the standard ones. However, the efficacy and safety of the new antiepileptic drugs in monotherapy, and their long-term safety have not been yet established, and they will cost more than the standard drugs. Therefore, the new antiepileptic drugs are currently considered as second choice drugs, although vigabatrin has been proposed as a first choice drug in West syndrome.