The 5th edition of Antiepileptic Drugs embodies the recent unprecedented expansion of the field of epilepsy as a clinical and scientific discipline as well as the concomitant progress achieved in the treatment modalities for this disease. As never before, antiepileptic drugs occupy a place of preeminence in neuropharmacology. Since the last edition, the number of clinically useful agents has continued to increase to the point that some speak of a “plethora” of antiepileptic drugs. This 5th edition includes 16 drugs even when benzodiapines, barbiturates and hydantoins are each counted as “one” drug. Clinicians are now challenged to develop rational therapeutic algorithms that include all the newly available agents. Indeed, as clinical experience accumulates with the “new drugs” of the last edition, particularly gabapentin, lamotrigine and topiramate, the distinction between “old” and “new” drugs is becoming blurred.
The straightforward format that has characterized previous editions has been retained and enhanced. The introductory section on General Principles has been modified with increased emphasis on the contributions and limitations of clinical trials and the importance of patient-related factors in the optimal use of drug therapy. New chapters have been added to discuss the treatment of status epilepticus as well as potential strategies for prevention of epileptogenesis. With respect to the section dealing with individual agents, the 16 drugs have been listed in alphabetical order from benzodiazepines to zonisamide. Presentation of information on each of these compounds has been modified by combining the aspects of chemistry, biotransformation and pharmacokinetics in one chapter and by adding, where appropriate, new chapters reflecting indications outside of epilepsy such as migraine prophylaxis, neuropathic pain and psychiatric disorders. Drugs with limited use (felbamate, primidone, vigabatrin) have been covered in a single chapter. The last section has been reduced in size to include only two drugs in clinical development, with an overview of drugs at earlier stages of development.
Authors who contributed to previous editions have updated their chapters and new authors have been selected on the basis of their expertise. The editors are aware of the potential conflict of interest that could arise when some authors from the pharmaceutical industry were invited to write about a drug marketed by their company. However, this could hardly be avoided, especially for chapters dealing with investigational drugs or areas of research (e.g., new indications) with little information in the public domain.
This edition has been targeted to meet the interests of various audiences. The book should be of special value to all neurologists and physicians involved in the treatment of epilepsy, but also to psychiatrists and to clinicians who manage patients with bipolar disorder, migraine, neuropathic pain and many other conditions in which antiepileptic drugs are increasingly used. The book should also be useful to academicians with an interest in epilepsy, and to pharmacologists, clinical pharmacists, and scientists involved in research and development of new antiepileptic drugs.
The editors wish to express their gratitude to the many distinguished authors who dedicated their invaluable time and expertise to contribute to this book. Special thanks are also due to Brian Rasmussen (University of Washington) and Raymond Reter (Lippincott Williams & Wilkins) for their diligence and heroic efforts in attending to the needs of all contributors and bringing this project to completion. The editors also thank Dr. Anne Sydor (Lippincott Williams & Wilkins) for her leadership and support. We all hope that this work, by facilitating dissemination of up-to-date information on drug therapy, will contribute to our common goal of improving the life of the over 50 million persons who suffer from epilepsy worldwide.