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This multiauthor review is based on a symposium on new antiepileptic drugs (AEDs). The book suffers from the usual difficulties with symposia publications including too many chapters which are often too short to usefully summarise the topic in detail but with much repetition and a lack of consistency and style. Nevertheless, excellent practical guidance is given in several chapters, including those on monotherapy, combination therapy, and the management of infants and children. For most patients with epilepsy none of the new AEDs are more effective than standard current first line treatment, with which we have many patient-years of experience. Marketing of the new drugs against these has leant heavily on negative campaigning (teratogenicity and female hormonal problems with valproate). Attempts to measure various aspects of quality of life have become important and these (particularly cognitive side effects) are considered in chapters including those by Chadwick and Aldenkamp. It comes as no surprise to learn that the single factor which most improves quality of life for patients is stopping seizures and most experience with these drugs has been obtained in that 20% of the epilepsy population with intractable seizure disorders. Treatment of this group of patients has been most improved after assessment by those with a special interest in epilepsy and identification of pseudoseizures, correct diagnosis of epilepsy syndromes requiring specific treatment, and identification of cases suitable for surgery. It is difficult to determine which of the new drugs are most beneficial in this treatment resistant group and as practical experience with the drugs in clinical practice is obtained it would be appropriate to design a randomised study comparing several of the new drugs against each other as add on or replacement therapy.
Further toxic effects of the new drugs are almost certain to be discovered. For example, at the time of the symposium the effect on visual fields of treatment with vigabatrin was not widely recognised and this is not covered in the text.