Medical Treatment

Antiseizure medications (ASMs) are the mainstay of treatment for epilepsy. Most people with epilepsy become seizure-free with ASMs, typically as monotherapy. A confirmed diagnosis, accurate classification, and risk stratification underpin the rational initiation of ASM. Pragmatic trial data inform the most effective and well-tolerated ASMs for first-line therapy of focal and generalised epilepsies. If seizure control is not achieved with first-line treatment, alternative monotherapies should be trialled sequentially. In the absence of clear trial data, awareness of the mechanisms of action, typical side effects, effective dose ranges, and interactions of the common ASMs facilitates the formulation of a polytherapy strategy. This can lead to a meaningful improvement in seizure control in a significant number of individuals with drug-resistant epilepsy. The risk of seizure recurrence on the withdrawal of ASM following a period of seizure freedom is highly dependent on several factors, and individuals need to be advised accordingly.