Objective: Perampanel, an antiseizure drug with αamino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist properties, may have a targeted effect in genetic epilepsies with overwhelming glutamate receptor activation.Epilepsies with loss of γaminobutyric acid inhibition (e.g., SCN1A), overactive excitatory neurons (e.g., SCN2A, SCN8A), and variants in glutamate receptors (e.g., GRIN2A) hold special interest. We aimed to collect data from a large rare ge-

Since epilepsy is a chronic disease of the nervous system that requires long-term therapy and regular intake of antiepileptic drugs, good tolerability of therapy is crucial for the quality of life of these patients. The main aim of antiepileptic treatment is the creation of a balance between the efficacy and tolerability of therapy. This literature review analyzes tolerability and safety of antiepileptic therapy. We paid particular attention to valproate, a drug that has been used for the treatment of epilepsy for more than 57 years. Valproate remains a basic drug with high efficacy and well-studied safety and tolerability. This review also covers the problems of epilepsy aggravation in response to some antiepileptic drugs, effects of antiepileptic drugs on cognitive functions, behavior, and mental sphere, as well as the issues of tolerability and safety of antiepileptic drugs in women of reproductive age.

Despite significant advances in epileptology, approximately one-third of patients suffer from drug-resistant epilepsy. Numerous approaches are currently available to treat epilepsy; however, there are still many patients with treatment-resistant epilepsy, in whom antiepileptic drugs are ineffective and surgical treatment is impossible. Thus, searching for new effective antiepileptic drugs and alternative treatments (such as vagus nerve stimulation) for these patients remains highly relevant. This literature review covers the indications for and the efficacy and tolerability of vagus nerve stimulation in patients with epilepsy. We also report a case of successful treatment of a patient with drug-resistant epilepsy using this method.

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