The Star Systems - Overview and use in determining antiepileptic drug choice

An explosion in antiepileptic drug (AED) therapy began in the 1990s with th e licensing of 9 new chemical entities and more to come. Important differen ces between AEDs may not be detected by regulatory trials, which are design ed to satisfy licensing requirements and often diverge considerably from ev eryday clinical practice. The Star Systems have been developed as evidence- based yet pragmatic and flexible models for comparing AEDs. Each drug has been judged across a range of criteria, including mechanism o f action, pharmacokinetics, ease of use, efficacy, tolerability, safety, in teraction profile and a 'comfort factor'. A score has been allocated under each category and systems have been devised fur patients with newly diagnos ed epilepsy and those with difficult-to-control seizures requiring combinat ion therapy. The choice of treatment should involve assessment of patient-related factor s, accurate classification of seizure type and syndrome, married with an un derstanding of the pharmacology of the AEDs. A staged management plan shoul d be formulated when initiating treatment with the aim of preventing the de velopment of refractory epilepsy. When using combinations of AEDs, the mech anism of action of each agent should be taken into consideration. Such an individualised approach to management will optimise the chance of a ttaining remission and help many more patients achieve a fulfilling life.