Focal epilepsy is the most common type of
epilepsy with approximately 30 million patients affected worldwide. There is a major challenge to develop new
antiepileptic treatments as currently approximately one third of patients remain uncontrolled under our best standards of care. Areas covered: An overview is given on first- and second generation
antiepileptic drugs and their mechanisms of action, and on recent new strategies for
antiepileptic targets, including drugs aiming at disease modification. Expert opinion: Newer
antiepileptic drugs have enabled a better tolerated and individualized treatment for many patients. Despite the successful history of
antiepileptic drug development programs, second and third generation
antiepileptic drugs targeting synaptic transmission have, however, failed to solve the problem of pharmacoresistance. New directions in pharmacological development include chronic models of
epilepsy in
drug screening and address primary and secondary epileptogenesis rather than focusing on the suppression of the symptoms, acute
seizures. There is hope that the new approaches will allow for patient stratification for targeted
therapy and will prove efficacy particularly in the patient group so far
drug resistant.