In the past 2 decades, 12 new antiepileptic drugs (AED) have been approved by the Food and Drug Administration for the treatment of epilepsy, making the selection process more complex. When choosing an AED several factors are considered including its relative efficacy, tolerability, serious toxicity, ease of use (determined by the pharmacokinetic profile and the drug-drug interaction potential), the presence of comorbid conditions, and cost. Age and gender are also important considerations. The tradition of recognizing a first-choice drug for a certain seizure type or epilepsy syndrome is no longer a practical concept. With so many AED available, depending on several factors, different patients with a similar type of epilepsy may be prescribed entirely different AED. The newer AED have shown no better efficacy than the classic drugs, but they are easier to use, with much better pharmacokinetic profiles and fewer drug interactions. The list of broad-spectrum drugs has greatly expanded, a major benefit for patients with generalized epilepsies. The long list of available AED has also benefited patients with epilepsy and comorbidities, often allowing for the use of drugs with positive or at least no negative effects on those conditions. Some practical recommendations on the selection of AED are provided in this article.
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