Lamotrigine versus other antiepileptic drugs: a star rating system is born.

With the launching worldwide of a range of new antiepileptic drugs (AEDs), the prescriber has a much wider choice than ever before. Comparative studies between new and established AEDs are few, and those between new AEDs are rarely performed. This report considers the strengths and weaknesses of nine new and established AEDs. Scores ranging from -2 to +2 are given under six headings: mechanism of action, pharmacokinetics, efficacy, side effects, drug interactions, and a comfort factor. Perceived advantages and disadvantages in their clinical use are summarized and a final "star rating" produced for each. This process is illustrated by a detailed critique of lamotrigine (LTG). The star system is intended to stimulate dialogue among epileptologists in reaching a consensus in the pharmacologic management of the epileptic patient.