Antiepileptic drugs - From scientific evidence to clinical practice

Introduction: Evidence based medicine establishes guidelines for clinical decision-making in which priority is given to processes that have the highest level of evidence. Although these guidelines provide valuable general guidance, the information is partial, because oftentimes obtaining evidence on antiepileptic drugs is promoted by commercial expectations and not by clinical priorities. Furthermore, the guidelines tend to classify different types of epilepsy into large groups, often without contemplating the different syndromes. Expert opinions are subject to criticism on the basis of methodology and their authoritarian aspect, although they can supplement medical literature and advice on specific clinical situations quickly and efficiently. Objectives: This review seeks to incorporate scientific evidence and expert opinion into drug treatment for epilepsy. Methods: To analyze this issue, a review of the literature was conducted by means of PubMed searches. Conclusion: We have found that in all types of epilepsy [except in IS focal epilepsy in children where a new drug (oxcarbamazepine) considered to be the first choice for initial treatment], classic drugs (valproic acid in idiopathic generalized epilepsy and carbamazepine in focal epilepsy) are recommended as long as there are no contra-indications due to adverse effects or concomitant use of other drugs that interact with the antiepileptics. However, despite the general recommendations, it can be deduced from the studies and reflections on the subject that the decision as to whether to start treatment or not, as well as the drug of choice, must be made on a case-by-case basis, taking into account the patient's personal and social circumstances.