Selection of antiepileptic drugs: a practical approach

The selection of antiepileptic drugs (AEDs) is increasingly more complex as new agents become available. We discuss an individualized approach to selection of an AED that is tailored to each patient's needs by considering the following six factors: effectiveness of the drug in controlling seizures, adverse effects profile, pharmacokinetic properties, special or unique patient situations, drug interactions, and cost of treatment. When these factors are considered, treatment complications and failure can be minimized by anticipating incompatibilities among drugs or between the drugs and the patient's condition. We emphasize the concept that the best AED therapy is dependent on optimal seizure control and absence of unacceptable side effects. In the current environment of medical practice, the cost of treatment has also become a major concern. With rare exceptions, no single factor dictates the choice of an AED. In the long term, the most cost-effective treatment will be the one that provides the most therapeutic benefit with the fewest complications and maximal patient satisfaction.