Emerging drugs for focal epilepsy

Introduction: Epilepsy is one of the most common serious neurological disorders in adults, affecting approximately 50 million people worldwide at a total annual cost, in Europe, of approximately 15.5 billion Euros. Areas covered: The present paper reviews current compounds in preclinical and clinical development for the treatment of focal epilepsies, namely, ganaxolone, perampanel, BGG-492, NS-1209, belnacasan, YKP-3089, brivaracetam. New formulations in clinical development, such as intranasal midazolam, diazepam auto-injection, a new formulation of valproic acid using drug targeting technology and controlled release formulations for topiramate and pregabalin, are also discussed. Expert opinion: During the last 30 years, antiepileptic drugs (AEDs) development have been based on specific assumptions regarding the neurobiology of epilepsy but all marketed drugs have not changed the proportion of drug refractory patients. AEDs in development with new mechanisms of actions, especially anti-inflammatory agents, are of interest. AMPA blockers, especially water-soluble ones, being suitable for parenteral formulation, can be of relevance in treating refractory status epilepticus, a major life-threatening complication. Finally, new formulations, especially those adopting drug targeting technologies are promising in order to maximize the efficacy with very limited adverse effects.