The availability of new antiepileptic drugs (AEDs) has expanded the spectrum of medical treatment options in epilepsy. However, the development of ten new compounds (vigabatrin, felbamate, gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, zonisamide, and pregabalin) has not changed the basic principles of epilepsy treatment. The choice of an AED depends upon seizure type or seizure syndrome, efficacy, safety, tolerability, patient age and gender, concomitant medication, and comorbid conditions. In general, most of the newer AEDs are not necessarily more effective but usually better tolerated than the traditional agents mainly because of their favorable pharmacokinetic profiles and fewer drug interactions. Because treatment options have been widened with the introduction of these new compounds, drug therapy can now be tailored to the requirements of the individual patient. Nevertheless, significant safety and efficacy issues continue to exist and there is a strong need for the development of even better agents. This clinical review focuses on current aspects of drug therapy in epilepsy.