Next-generation antiepileptic drugs: what they do and who they help

If old seizure medicines stopped working or caused too many side effects, newer antiepileptic drugs can change the game. These drugs target different brain pathways and are often tested in people who didn’t respond to older treatments. They aren’t miracle cures, but for many patients they reduce seizure frequency, improve daily life, or offer better tolerability.

How these new drugs work

Newer medicines attack seizures in more specific ways. For example, brivaracetam and levetiracetam bind to the SV2A protein on nerve cells, reducing abnormal firing. Lacosamide and cenobamate act on sodium channels but in different ways than older sodium blockers — that can help people whose seizures resist older drugs. Perampanel blocks AMPA receptors, which lowers excitatory signaling in the brain. Cannabidiol (prescription Epidiolex) works through multiple pathways and is approved for certain pediatric syndromes. Fenfluramine, originally known for other uses, now helps some severe childhood epilepsies by adjusting serotonin signaling.

Each drug suits different seizure types and ages. For example, cannabidiol and fenfluramine are mainly used for rare childhood syndromes like Dravet and Lennox-Gastaut, while cenobamate, lacosamide, brivaracetam, and perampanel are options for focal (partial) seizures in adults and teens.

What patients should know: benefits, risks, and how to get them

These drugs can reduce seizures when older meds fail, but they come with trade-offs. Side effects often include dizziness, sleepiness, mood changes, or coordination problems. Some drugs need slow dose increases to lower side effects or special monitoring — for example, liver tests, heart checks, or mood monitoring. Perampanel can sometimes cause irritability or aggression in a small number of people. Cannabidiol may raise liver enzymes and interacts with other epilepsy drugs, so doctors check labs carefully. Fenfluramine requires heart monitoring because of past safety concerns.

Because interactions matter, tell your doctor about all meds you take, including over-the-counter drugs and supplements. Many of these newer medicines interact with liver enzymes (CYP), which can change how other drugs work. If you’re pregnant or planning pregnancy, discuss risks and alternatives with your neurologist — pregnancy concerns vary by drug.

How to proceed: ask your neurologist whether genetic testing, seizure type review, or a second opinion at an epilepsy center could point to a specific new drug or a clinical trial. These drugs require prescriptions and follow-up — don’t try to buy them without a doctor’s guidance. If cost is an issue, ask about manufacturer assistance, prior authorization tips, or patient programs that can help with copays.

New antiepileptic drugs won’t fit everyone, but they expand choices. Talk clearly with your epilepsy specialist about what matters most to you — fewer seizures, fewer side effects, or easier dosing — and build a plan that matches your life and goals.