A 2017 review of pharmacotherapy for treating focal epilepsy: where are we now and how will treatment develop?

ABSTRACT

Introduction: Focal epilepsy is the most common type of epilepsy with approximately 30 million patients affected worldwide. There is a major challenge to develop new antiepileptic treatments as currently approximately one third of patients remain uncontrolled under our best standards of care.

Areas covered: An overview is given on first- and second generation antiepileptic drugs and their mechanisms of action, and on recent new strategies for antiepileptic targets, including drugs aiming at disease modification.

Expert opinion: Newer antiepileptic drugs have enabled a better tolerated and individualized treatment for many patients. Despite the successful history of antiepileptic drug development programs, second and third generation antiepileptic drugs targeting synaptic transmission have, however, failed to solve the problem of pharmacoresistance. New directions in pharmacological development include chronic models of epilepsy in drug screening and address primary and secondary epileptogenesis rather than focusing on the suppression of the symptoms, acute seizures. There is hope that the new approaches will allow for patient stratification for targeted therapy and will prove efficacy particularly in the patient group so far drug resistant.

KEYWORDS:

• Antiepileptic drug
• pharmacoresistance
• neurotransmission
• epileptogenesis
• disease modification

Article highlights

• New antiepileptic drugs have provided incremental progress in controlling epileptic seizures.

• Recent antiepileptic drugs with synaptic targets have improved tolerability more than efficacy.

• Drugs in the pipeline also address extrasynaptic mechanisms.

• Modulation of additional pathways relevant for epileptogenesis and disease progression are in the focus of ongoing drug development.

• mTOR inhibitors are the first available drugs interfering with disease specific mechanisms of epileptogenesis.

This box summarizes key points contained in the article.

Declaration of interest

A. Schulze-Bonhage has received study support and honoraria from Bial, Cyberonics, Desitin, EISAI, Precisis and UCB Pharma. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.