Opinion statement
Effective treatment of seizures resulting from epilepsy relies on several basic principles, regardless of which drug or treatment is selected. Treatment starts with a confident diagnosis that the symptoms are, indeed, seizure. The seizure type should be classified as focal in onset or primary generalized, and there should be a relentless search for the etiology. Many antiepileptic drugs (AEDs) are available to treat partial-onset seizures. Given that the efficacy of AEDs is comparable, selection of the appropriate drug is mostly determined by whether any comorbidities are present, such as migraine, obesity, depression, or chronic pain. In the absence of comorbidities, it depends on the side effect profile, cost, and convenience. Most AEDs, with a few exceptions, must be increased to a maximum tolerated dose before a second drug should be added. Most patients can become seizure free or adequately controlled if continued interventions are considered at each encounter until patients are seizure free.
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Disclosure
Dr. Shneker has received grant support from UCB, Pfizer, Eisai, GlaxoSmithKline, and Bial. Dr. Fountain has received grant support from the National Institutes of Health, UCB, Lundbeck, Medtronic, NeuroPace, Vertex Pharmaceuticals, SK Life Science, and Upsher-Smith Laboratories; has received royalties from Wolters Kluwer; and has had travel expenses covered/reimbursed by UCB.
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Shneker, B.F., Fountain, N.B. Antiepileptic Drug Selection for Partial-Onset Seizures. Curr Treat Options Neurol 14, 356–368 (2012). https://doi.org/10.1007/s11940-012-0186-5
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DOI: https://doi.org/10.1007/s11940-012-0186-5