Timing use of novel anti-epileptic drugs: is earlier better?

Epilepsy is one of the most common neurological disorders. The goal of pharmacologic therapy remains complete freedom from seizures with minimal side effects. Despite advancements and the development of third-generation antiepileptic drugs (AEDs), a third of patients with epilepsy remain refractory to pharmacotherapy. The present manuscript is based on an extensive Internet and PubMed search from 2004 to 2019. It is focused on the third-generation AEDs (e.g. lacosamide, eslicarbazepine, perampanel, and brivaracetam). Newer antiepileptic drugs are increasingly used. However, how early in the course of epilepsy third-generations AEDs should be used is still unclear. Third-generation AEDs may offer better tolerability, milder adverse effects, less drug interactions and improved pharmacokinetic characteristics compared to the conventional AEDs. For this reason, the third-generation AEDs may be used earlier and earlier in epileptic patients. Further head-to-head comparisons are needed to determine the exact position of third-generation AEDs relative to conventional AEDs.