Multiple factors contribute to the increased risk of cognitive and emotional deficits experienced by patients with epilepsy, including both the underlying disease state from which they suffer and the psychosocial disruption in their lifestyles that their seizures can produce. While antiepileptic drugs (AEDs) have the potential to reduce such risks by reducing seizure activity, they can also compound problems by dampening neuronal excitability throughout the brain and altering underlying neurochemical systems that impact thinking and mood. Therefore, for optimal treatment of epilepsy, one must achieve a balance between adequate seizure control and minimizing the potential side effects of the employed AEDs. This requires knowledge of the specific cognitive and behavioral effects of both established newer AEDs and an understanding of the general principles governing their delivery.