TY - CHAP M1 - Book, Section TI - Chapter 562. Epilepsy Treatment: Antiepileptic Drug Therapy A1 - Bourgeois, Blaise F. D. A2 - Rudolph, Colin D. A2 - Rudolph, Abraham M. A2 - Lister, George E. A2 - First, Lewis R. A2 - Gershon, Anne A. PY - 2011 T2 - Rudolph's Pediatrics, 22e AB - Although other treatment modalities, such as the ketogenic diet, epilepsy surgery, and the vagus nerve stimulator, are appropriate options at some point for certain patients, antiepileptic drugs (AEDs) represent almost invariably the first and, in the great majority of patients, the only treatment in patients diagnosed with epilepsy. Until 1993, 4 AEDs represented more than 90% of all prescriptions for epilepsy: phenobarbital, phenytoin, carbamazepine, and valproate. These drugs are now referred to as the “older” AEDs. Adrenocorticotropic hormone (ACTH) was available but was used only for limited specific indications. Since 1993, many “newer” AEDs have become available. As a group, most of these newer drugs offer welcome alternatives with less or different side effects, fewer or no pharmacokinetic interactions, and a spectrum of efficacy that covers a wider range of different seizure types. However, despite the availability of these newer drugs, the percentage of patients whose seizures can never be fully controlled by medication has not been reduced and remains around 25% to 30% of all patients diagnosed with epilepsy. With so many AEDs to choose from, the challenge of matching the best possible drug to a given patient has grown substantially. The first goal of therapy is to find as rapidly as possible the AED that will provide the best possible seizure control while maximizing tolerability and safety. The currently available evidence-based guidelines address only a small proportion of the seizure types and syndromes, and selecting the most appropriate drug will also involve clinical experience and art.1,2 Often the choice will have to be tailored for a given patient, and in addition to seizure type and epilepsy syndrome, personal characteristics of the patient will have to be taken into account, such as gender, age, comorbid conditions, other medications, and lifestyle. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=7057962 ER -