VLADIMIRHACHINSKIMD, FRCPC, DScMed
EPILEPSY IS a common and complex syndrome, affecting about 1% of the world's population. Phenobarbitone, phenytoin, valproate sodium, and carbamazepine remain the main drugs of monotherapy, giving adequate control in more than half of patients. The challenge and the costs increase with refractory seizures, with each drug required being relatively less effective.
As Chadwick points out, the newer drugs can offer advantages in providing similar efficacy with greater tolerance, having a better safety profile, or acting through a different mechanism than the standard medications. All the new drugs are more expensive but this has to be weighed against the cost of poor seizure control.
Hachinski V. New Antiepileptic DrugsThe Cost of Innovation. Arch Neurol. 1998;55(8):1142. doi:10.1001/archneur.55.8.1142