Mechanisms of action and clinical use of antiepileptic drugs

Treatment choices for epilepsy are made empirically, but drug responses and adverse effects can in part be predicted on the basis of the known mechanisms of action of the drugs. Antiepileptic drugs act by inhibiting voltage-gated sodium or calcium channels, opening potassium channels, enhancing gamma-aminobutyric acid (GABA)-mediated inhibition in the brain, inhibiting glutamate-mediated excitatory function or by altering intracellular signaling pathways. Knowledge of the mechanisms of action is essential when assessing the applicability of antiepileptic drugs in other indications such as in the management of pain and psychiatric symptoms.