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NEUROLOGY 1983;33:2-7
© 1983 American Academy of Neurology

Historical perspective on the choice of antiepileptic drugs for the treatment of seizures in adults

Dennis B. Smith, Antonio V. Delgado Escueta, Joyce A. Cramer and Richard H. Mattson

Neurology Service (Dr. Smith), Veterans Administration Medical Center, Forest Hills Division, Augusta, GA, Epilepsy Research (Mrs. Cramer) and Epilepsy Center (Dr. Mattson), Veterans Administration Medical Center, West Haven, CT, and Comprehensive Epilepsy Program (Dr. Escueta), Southwest Veterans Administration Regional Epilepsy Center, Wadsworth Veterans Administration Medical Center, Los Angeles, CA.

Address correspondence and reprint requests to Mrs. Cramer, Study Coordinator, Epilepsy Research (127), VA Medical Center, West Haven, CT 06516.

Although numerous reports have appeared in the literature over the past 100 years describing various antiepileptic drugs, it is not possible to justify preference for a particular drug to treat specific types of adult seizures. Since the introduction of bromides a century ago, numerous antiepileptic drugs have been developed. Four such drugs, carbamazepine, phenobarbital, phenytoin, and primidone, have been found to be effective and acceptably safe for management of partial and secondarily generalized seizures. However, no studies have demonstrated the superior efficacy of any one drug. Clinical selection of therapy often is based on expected or assumed risk or absence of specific side effects. This review of classic papers demonstrates inconclusive and conflicting information. A new approach to the comparative evaluation of the efficacy and toxicity of major antiepileptic drugs is needed.

Supported by the Veterans Administration Medical Research Service Cooperative Studies Program.

Accepted for publication August 26, 1982.






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