According to a commentary, this trial provides robust evidence supporting its use as monotherapy for newly diagnosed epilepsy. It suggests that use of these findings to approve lacosamide would add this drug to the few other treatments already available for such an indication. Currently lacosamide is only licensed as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent patients with epilepsy. The commentary notes that although the European Medicines Agency recommends that monotherapy studies of antiepileptic drugs should be started “as early as the development of the medicinal product allows, in order to avoid an excessive delay in obtaining a marketing authorization for monotherapy”, unnecessarily restrictive regulatory requirements for monotherapy trials to be separate from those of drugs as adjunctive therapy limit marketing approval. It suggests that regulatory agencies should consider adaptive sequential licensing, whereby a new antiepileptic drug would be approved simultaneously for adjunctive and second-intention monotherapy and then, after specified safety milestones are met, receive an unrestricted monotherapy licence”.