Anti-seizure medications (ASMs): choice with generalized seizures
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Anti-seizure medications (ASMs): choice with generalized seizures. Valproate is the first line choice. Fully referenced neurology checklist.
Generalized tonic-clonic seizures: Level C evidence
- Valproate is the first line choice
- Lamotrigine: if Valproate is unsuitable
- Phenobarbitone
- Topiramate
- Carbamazepine: this may also worsen the seizures
- Phenytoin: this may also worsen the seizures
- Avoid Oxcarbazepine
Generalized tonic-clonic seizures: Level D evidence
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Juvenile myoclonic epilepsy (JME): Level D evidence
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Juvenile myoclonic epilepsy (JME): other options
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Juvenile myoclonic epilepsy (JME): myoclonus-exacerbating drugs to avoid
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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.
- The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. NICE Clinical Guideline [CG137]. January 2012.
- Marson A, Burnside G, Appleton R, et al. The SANAD II study of the effectiveness and cost-effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet 2021; 397:1375-1386.
- Perucca E, Tomson T. The pharmacological treatment of epilepsy in adults. Lancet Neurol 2011; 10:446-456.
