The medical management of epilepsy

With many new medications on the market and new data about the various side-effects of antiepilepsy drugs (AEDs), the medical management of epilepsy can seem unnecessarily complicated for the non-specialist. The process can be thought of taking place in 7 steps: 1) assessing the need for medications; 2) defining the seizures and classifying the epilepsy syndrome; 3) knowing which medications are best used in which syndromes; 4) taking into account patient priorities when choosing a medication, such as cotreatment or avoidance of neurobehavioral issues and weight loss or gain; 5) considering other life issues, such as planning a pregnancy and breastfeeding; 6) choosing a maintenance dose and deciding when to consider a change to another medication or to use dual therapy; and 7) if seizure-free, which patients to consider AED reduction or withdrawal. The goal is simply, no seizures and no side-effects. Seizure freedom is an important goal to reduce injury, mortality and improve quality of life. Improving tolerability is equally as important, as both acute and chronic side-effects of AEDs can be as disabling as seizures themselves.