DRUG-TREATMENT OF EPILEPSY IN THE 1990S - ACHIEVEMENTS AND NEW DEVELOPMENTS

There have been significant advances in the medical treatment of epile psy in recent years. Improved formulations of several classical antiep ileptic drugs (AEDs) have appeared, resulting in improved efficacy and decreased toxicity. A marked increase in the number of comparative in vestigations of AEDs has also made treatment choice somewhat simpler. Rational methods applied in the search for new AEDs have resulted in t he introduction of several new AEDs. So far, evidence seems to indicat e that progress has been made with regard to developing compounds not necessarily with superior efficacy but with simpler pharmacokinetics, avoiding enzyme induction as well as decreasing the number of interact ions, and improving adverse effect profiles, in comparison to the prev ious generation of AEDs. A novel approach to the clinical testing of A EDs has made it possible to demonstrate unequivocal efficacy, as well as efficacy as monotherapy, very early in the development of novel com pounds. Results of studies from developing countries seem to raise dou bt with regard to the value of the old dogmatic principle that early t reatment is important in terms of the long term prognosis for seizure control. Traditional ideas on the value of monotherapy have also been questioned on the basis of a novel concept of so-called 'rational poly therapy' which, however, still await scientific validation. On the bas is of excellent epidemiological and large controlled clinical studies, our ideas of the necessary duration of AED treatment have become much more optimistic than before.