Epilepsy is one of the most common neurological disorders with a preva
lence rate of 0.5-1%. Nowadays, antiepileptic drugs are developed rati
onally from an understanding of basic mechanisms in epileptogenesis an
d neurotransmitters rather than from an empirical screening program as
in the past. The most promising drugs are presented: Lamotrigine, a f
olate-antagonist, reduces the release of excitatoric neurotransmitter
glutamate. 30% of drug resistant epileptic patients showed an improvem
ent of seizure frequency with a reduction of more than 50%. There was
a remarkable effect on primary generalized seizures. Oxcarbazepin (OXC
), the 10-ketoanalogon of Carbamazepin (CBZ) presented with the same e
xcellent anticonvulsive action like CBZ, but had significantly less si
de effects because of its different metabolic pathways. Since the hepa
tic microsomal systems is not involved during metabolisation, there is
no relevant auto- or heteroinduction, so that this drug should be the
first choice for any comedication. Gamma-Vinyl-GABA (Vigabatrin), a >
>designer drug<<, is a selective irreversible inhibitor of GABA-transa
minase leading to a long persisting increase of the inhibitory GABA ne
urotransmitter in the central nervous system with high efficacy in com
plex-partial seizures. Relevant side effects are a reversible toxic my
elin edema in animal experiments and the activation of psychosis in a
defined risk population.