Third generation antiepileptic drugs: mechanism of action, pharmacokinetics, interaction and use in childhood

Abstract

The review considers pharmacological characteristics of new antiepileptic drugs (AEDs) of the third generation such as eslicarbazepine, lacosamide, retigabine, perampanel, everolimus, brivaracetam, zonisamide. The data on the mechanisms of action, pharmacokinetics, drug interactions, indications for use and side effects are presented. The drugs are recognized as superior in safety and efficacy to previously known AEDs of the first and second generations. The majority of new AEDs is used to control focal seizures, as well as in specific epileptic syndromes (Lennox–Gastaut syndrome, Dravet syndrome), and tuberous sclerosis. The drugs differ in the mechanism of action, pharmacokinetic properties, effectiveness and profile of side effects, which account for an opportunity to apply a personalized approach to patient treatment. Properly selected therapy allows to achieve good control over epileptic seizures as well as lower a risk of disease-related complications. While prescribing AEDs, it is necessary to take into account their pharmacokinetic and pharmacodynamic features.