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

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.