Idiopathic (primary) generalized epilepsy. Traditional versus new antiepileptic drugs

Abstract

Idiopathic generalized epilepsies (IGE) are genetic based seizures with normal neurologic exam, intelligence, and imaging studies. Based on the age of onset and prominent seizure type, different syndromes were identified. The purpose of this study is to summarize the characteristics, prognosis, and choices of antiepileptic drugs (AED) in common syndromes of IGE. In addition, we review the updated role of new AEDs in specific syndromes of IGE. The first choice AED is usually valproate. Most drug trials on the effects of new AEDs compared them with placebo and not valproate. However, some of the broad spectrum new AEDs may be considered as the first choice in specific conditions. In true refractory patients, combination therapy and vagal nerve stimulation could be the next option. In the proper management of IGE, neurologists should consider the predominant seizure type, patient gender, co-morbidities, and antiepileptic drugs that may aggravate a specific seizure type.