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The advent of the second-generation antiepileptic drugs ushered in a period of improved management of patients with epilepsy. The introduction of these agents began in 1993 and greatly expanded the available epilepsy treatment options. Currently, 11 second-generation antiepileptic drugs (AEDs) are approved for use in the United States. Table 4-1 provides a summary of the available second-generation AEDs. Due to the regulations of the Food and Drug Administration (FDA) with respect to studying AEDs in the United States, many of these agents are initially approved as adjunctive agents. In essence, they are added to an established therapeutic regimen of patients being managed primarily with a first-generation AED (i.e., carbamazepine, phenobarbital, phenytoin, or valproic acid). Most of them are approved for use as adjunctive therapy in the management of partial seizures with or without secondary generalization, primary generalized tonic-clonic seizures, or myoclonic seizures. As more data emerge, monotherapy approval for these agents may be pursued and the use of these agents will inevitably be expanded in clinical practice. At times, these agents may also be used for nonepileptic purposes. For example, gabapentin and pregabalin, while initially used for seizure management, are used almost exclusively today for the management of neuropathic pain and other pain syndromes.

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TABLE 4-1Summary of Second-Generation Antiepileptic Drugs

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