The treatment of epilepsy is complicated and often fails to achieve the one main goal of treatment – the elimination of seizures. Far too often patients are treated with multiple drugs that lead to serious adverse events or drug-drug interactions and still have seizures that impair their ability to function. There is an ever-present need for newer, more effective agents with fewer side effects and less complicated drug-drug interactions. Clearly, there is a significant place for pharmacists in assuring appropriate treatment and monitoring is provided for epilepsy patients.

Since 2009, five, new antiepileptic (AEDs) have been approved by the US Food and Drug Administration (FDA) including vigabatrin, rufinamide, clobazam, ezogabine, and lacosamide. These drugs are all unique in their pharmacology and their indications, including atonic seizures, Lenox-Gastaut syndrome, infantile spasms, and add-on for partial epilepsy. Just recently, on October 22, 2012, the FDA approved yet another agent for the treatment of partial-onset seizures in people with epilepsy – perampanel (Fycompa®, Eisai, Inc]. The search for better agents to treat, and perhaps even cure, epilepsy continues.

This issue of the Mental Health Clinician features articles highlighting the newest trends in epilepsy treatment and some of the controversies. Cristofer Price, Pharm.D., and Melody Ryan, Pharm.D., MPH, BCPS, review eslicarbazepine (Stedesa®), which is expected to receive FDA approval in late 2012 or early 2013. This agent is effective for the treatment of partial onset seizures in adults with epilepsy. Dr. Ryan also answers some questions about her practice in epilepsy and provides great insight as to how a pharmacist can help manage difficult AED regimens. Jason Noel, Pharm.D., BCPP, provides a thoughtful discussion of the controversy of generic substitution of AED drugs and how pharmacists have the responsibility of assuring patient safety when generic AEDs are substituted for the brand name product. Jacquelyn Bainbridge, Pharm.D., FCCP, and Caleb Ho, Pharm.D., discuss the risk of seizures from psychotropic drugs. Dr. Bainbridge with Lisa Hong, PharmD candidate, describe the role of serotonin in seizures and the anticonvulsant effects from SSRIs. Nicole Phelps, Pharm.D., provides a clinical pearl on the use of phenytoin with enteral feedings, a drug-food interaction with a significant impact on the effectiveness of phenytoin. And lastly, Anne Eudy, Pharm.D., and Dr. Bainbridge provide several clinical pearls on AEDs including initiation of AEDs, combinations of AEDs, and significant drug-drug interactions involving AEDs.

I hope you enjoy this exciting issue of the Mental Health Clinician!