Treatment Guidelines from The Medical Letter
Drugs for Epilepsy
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Revised 10/22/13: The topiramate section of Table 2 has been revised.

Treatment of epilepsy should begin with a single drug, increasing the dosage gradually until seizures are controlled or adverse effects become unacceptable. If seizures persist, expert clinicians generally prescribe at least one and sometimes a second alternative drug as monotherapy before considering use of two drugs at the same time. When used for the appropriate seizure type, antiepileptic drugs are roughly equivalent in efficacy. The choice of drug is usually based on factors such as ease of use, adverse effects, interactions with other drugs, presence of comorbid conditions and cost.1

Controlled trials are difficult to conduct in patients with epilepsy; use of a placebo would be unethical, and patients whose seizures are controlled by one medication are understandably reluctant to be randomized to another. Newer antiepileptic drugs (AEDs) are usually initially approved by the FDA only as ... more      

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Title: Drugs for Epilepsy
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