First-choice Antiepileptic Drugs

One must carefully differentiate between seizures seen in the neonate, child, or adolescent, as the same seizure type may represent completely different epilepsy syndromes and may require different types of therapy depending on the patient’s age. In addition, for those with lesional epilepsy who are possible candidates for surgery, brain plasticity offers a special opportunity for early surgical intervention. These children may need only brief drug treatment after more definitive therapy. Perhaps most importantly, a single seizure may not need therapy at all, especially if it was unprovoked. A decision to treat usually depends on whether seizure activity recurs or whether multiple risk factors for recurrence are present. Efficacy is the first consideration, but AED selection may be equally dependent upon concomitant diagnoses, expected length of therapy, and perception of side effects.