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Drug\u2010resistant epilepsy (DRE) is associated with cognitive and psychiatric comorbidities, socioeconomic impairment, injuries, and a 9.3\u201313.4 times higher mortality rate than in seizure\u2010free patients. Improved seizure control can reduce morbidity and mortality. Two new ASMs were launched in the United States in 2020: cenobamate for focal epilepsy in adults and fenfluramine for Dravet syndrome (DS). They offer markedly improved efficacy. Cenobamate achieved 21% seizure freedom with the highest dose and decreased tonic\u2013clonic seizures by 93% during maintenance treatment in a randomized clinical trial (RCT). In long\u2010term, open\u2010label studies, 10%\u201336% of patients were seizure\u2010free for a median duration of ~30\u201345\u2009months. Fenfluramine treatment in DS reduced convulsive seizure frequency by 56% over placebo at the highest dose, with 8% of patients free of convulsive seizures, and 25% with only one convulsive seizure over 14\u2009weeks. These results were sustained for up to 3\u2009years in open\u2010label extension studies. Mortality was reduced 5\u2010fold. These results are superior to all other approved ASMs, placing these two drugs among the most effective antiseizure therapies. The adverse event profiles resemble those of other ASMs. Despite greater efficacy and similar toxicity, these medications are infrequently used. Two years after US market entry, &lt;\u20095% of either adults with focal DRE or patients with DS were treated with either cenobamate or fenfluramine. We believe this is a failure of our medical system, resulting from limited knowledge about these drugs stemming partly from the separation of academia from industry; restrictions to access created by health care payors, hospitals, and regulatory agencies; and insufficient post\u2010launch information about the efficacy and safety of these ASMs.<\/jats:p>","DOI":"10.1111\/epi.17564","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T05:20:05Z","timestamp":1677648005000},"page":"1458-1465","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Failure to use new breakthrough treatments for epilepsy"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7244-3722","authenticated-orcid":false,"given":"Pavel","family":"Klein","sequence":"first","affiliation":[{"name":"Mid\u2010Atlantic Epilepsy and Sleep Center  Bethesda Maryland 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