A new look at the second-generation antiepileptic drugs - A decade of experience

Objective: To review data from the literature regarding the efficacy and tolerability of the second-generation antiepileptic drugs which were approved by the Food and Drug Administration (FDA) since 1994. Methods: A MEDLINE search of the literature, as well as review of bibliographies, was performed to identify randomized controlled trials and other reports evaluating efficacy, pharmacokinetic profile, adverse effects, and drug interactions of the second-generation antiepileptic drugs. Key search terms included felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide, and pregabalin. Results: Each of the second-generation antiepileptic drugs has demonstrated statistically significant reductions in seizure frequency over baseline compared with placebo or active control. Limited studies of efficacy of the new agents compared with the traditional antiepileptic drugs found no significant differences. Each of the second-generation antiepileptic drugs has a unique pharmacokinetic and side-effect profile. Compared with the traditional agents, the second-generation antiepileptic drugs have fewer serious adverse effects, as well as drug interactions. Conclusion: Knowledge of the second-generation antiepileptic drugs has greatly expanded over the past decade. The newer agents offer many options in the treatment of epilepsy that are safe, efficacious, and well tolerated.