Introduction: Despite optimal medical treatment, up to 30% of patients with epilepsy continue to experience recurrent seizures, and the challenge for new more efficacious and better-tolerated drugs is continuing. New antiepileptic drugs include the evolution of preexisting drugs and new compounds identified through the investigation of additional molecular targets, such as SV2A synaptic vesicle protein, voltage-gated potassium channels, ionotropic and metabotropic glutamate receptors, and gap junctions.
Areas covered: We report the available data about different classes of molecules that are in the pipeline for treatment of focal epilepsy. We will present data available on drugs derived from the evolution of preexisting anticonvulsants. We will then report the results on clinical trials performed with new compounds identified through the investigation of additional molecular targets.
Discussion: The challenge for new, more efficacious, more specific, and better-tolerated drugs is continuing and a better knowledge of mechanisms underlying epilepsy should represent the guide for future research. The ultimate goal of treatment should be not only to render the patients seizure free but also to improve the quality of life and reduce costs of medical care.