The number of antiepileptic drugs (AEDs) useful in the Rx of epilepsy has doubled in the past 4 years. Ln addition to the major older drugs (phenytoin, carbamazepine, valproate, ethosuximide, and phenobarbital), the FDA has approved felbamate, gabapentin, lamotrigine, fosphenytoin, and topiramate for the treatment of epilepsy in adults. Tiagabine has received an approvable letter and vigabatrin is under consideration. Felbamate has been approved for the treatment of partial seizures in adults and specific childhood disorders. Fosphenytoin, a parenteral anticonvulsant, has been approved for status epilepticus in adults and has not been restricted from use in children. Even though all of these new AEDs have been approved for use in adults, they have been used by clinicians for treatment of many of the childhood epilepsy syndromes. The choice of treatment has become more complex and drug selection will be made with consideration being given to efficacy in specific syndromes, adverse effects, benefit-to-risk ratio, drug pharmacokinetics, and cost, The newer drugs have been tested rigorously in partial and secondarily generalized seizures and adverse effect profiles in add-on treatment trials have been identified. However, rare idiosyncratic reactions will only be known after many thousands of drug exposures in epileptic patients.
