Appropriate use of medications for seizures. Guiding principles on the path of efficacy

Selection of medication for treatment of seizures requires careful consideration and a multifactorial, individualized evaluation. First and foremost, the choice of a particular AED should be based on its efficacy against the seizure type or types or epilepsy syndrome being treated. Other factors, such as concomitant medical conditions, may also play a role in the type or dosage of medication prescribed. (For example, dosages of topiramate and levetiracetam should be adjusted in patients with renal impairment, and dosages of tiagabine should be adjusted in patients with liver dysfunction.) Other guidelines, discussed in detail in this article, can be applied irrespective of the particular drug chosen. Because the presence of epilepsy can have a significant bearing on quality of life, the decision to discontinue treatment should be made in congruence with the patient's needs, wishes, and commitments.