Neurology
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The challenges of treating patients with partial seizures soon will be met, in part, by a number of new additions (felbamate, gabapentin, lamotrigine) to existing treatment options. Gabapentin, has shown significant promise in the treatment of patients with refractory partial seizures and secondarily generalized tonic-clonic seizures. Three large, randomized, multicenter, double-blind, placebo-controlled, parallel-group clinical trials have established its efficacy and safety as add-on therapy in patients with refractory partial seizures. ⋯ To date, serious adverse events have been rare. Long-term safety data are needed. The lack of drug interaction potential between gabapentin and traditional antiepileptic drugs also was confirmed in clinical trials.
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Significant progress in the classification, diagnosis, and pharmacologic management of epileptic seizures has occurred over the past two decades, but epilepsy remains a therapeutic challenge. Clinical studies show that most patients with epilepsy can have complete or almost complete seizure control with optimally managed monotherapy that employs a traditional antiepileptic drug (AED). About half of the remaining patients can obtain improved seizure control with combination antiepileptic drug therapy, but usually with more adverse effects. ⋯ Advances in understanding the pathogenesis of epilepsy and the mechanisms of action of antiepileptic drugs have provided a basis for the development of new AEDs that hold promise for difficult-to-treat patients. In this decade, a number of new AEDs that may overcome some of the disadvantages of traditional AEDs and offer clinicians and patients added therapeutic options will become clinically available. These will be more fully evaluated for their clinical potential to meet existing challenges of epilepsy treatment.