MEDICAL-MANAGEMENT OF EPILEPSY IN ADULTS

Optimal treatment of epilepsy in adults requires a tailored approach t hat weighs the efficacy of individual drugs in the specific diagnosis against the patient's risks for adverse events. Partial seizures, whic h are the most common seizure type in adults, can be effectively contr olled by virtually all the standard and newer antiepileptic drugs (AED s). For the generalized epilepsies, valproate remains the drug of choi ce. Data continue to accumulate regarding use of the newer agents. Ove rall, many of the newer AEDs may offer a better tolerability than the standard agents because of more favorable pharmacokinetic characterist ics and lack of interactions with drugs other than AEDs. Serious adver se events have been associated with felbamate and lamotrigine, however , and more experience is needed with many of the other newer AEDs to b etter define their safety profiles. Monotherapy should be the goal whe n AED treatment is instituted for the adult with epilepsy. Dosage modi fication on the basis of seizure control and toxicity should be implem ented, as well as single-drug trials with alternative AEDs, before res orting to polytherapy. With the introduction of several promising newe r AEDs, safe and effective seizure control may become a reality for an increasing number of adults with epilepsy.