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

Introduction: 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. Areas covered: 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). Expert opinion: 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.