Anti-seizure medications (ASMs): choice with focal seizures
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Anti-seizure medications (ASMs): choice with focal seizures. Lamotrigine: this is the first line agent. Fully referenced neurology checklist.
Partial-onset seizures: Level A and B evidence
- Lamotrigine: this is the first line agent
- Carbamazepine
- Levetiracetam: this is Level C in other guidelines
- Zonisamide
- Phenytoin
- Valproate
Partial-onset seizures: Level C and D evidence
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Partial-onset seizures in the elderly: Level A evidence
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Partial-onset seizures in the elderly: Level C and D evidence
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Drug combinations to avoid
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References
- Glauser T, Ben-Menachem E, Bourgeois B, et al; ILAE Subcommission on AED Guidelines. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013; 54:551-563.
- Marson A, Burnside G, Appleton R, et al. The SANAD II study of the effectiveness and cost-effectiveness of levetiracetam, zonisamide, or lamotrigine for newly diagnosed focal epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet 2021; 397:1363-1374.
- Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2018; 91:74-81.
- Perucca E, Tomson T. The pharmacological treatment of epilepsy in adults. Lancet Neurol 2011; 10:446-456.
