Advances in drug therapies for epilepsy have been remarkable, as well as surgical treatment including vagus nerve stimulation, the neuropsychological approach, and the new ketogenic diet. Over these past several years, four drugs (gabapentin, topiramate, lamotrigine,and levetiracetam)have been approved in Japan as new antiepileptic drugs and are expected to bring many benefits to patients. These new antiepileptic drugs have gained attention as leading candidates for “rational polytherapy”.Furthermore,these drugs are very attractive to psychiatrists because of their effects on mood disorder,pain disorder,headaches, obesity,and other problems.Thus,the introduction of these new antiepileptic drugs is greatly welcomed in that the therapeutic options for patients are broadened.At this point,however, we should refrain from easy off-label drug use and should definitely comply with the recommended dosage regimens.In addition,several adverse effects require attention,such as severe rash or effects on cognitive function.Currently,the dominance in efficacy of these new drugs as compared with established antiepileptic drugs is not definite, and the issue of industrysponsorship bias should be taken into consideration.