Query: The main anti convulsant drug?

Response:

Generalised tonic-clonic (GTC) seizures

First-line treatment: offer sodium valproate as first-line treatment. Offer lamotrigine if

sodium valproate is unsuitable. If the person has myoclonic seizures or is suspected of
having juvenile myoclonic epilepsy (JME), be aware that lamotrigine may exacerbate
myoclonic seizures. Consider carbamazepine and oxcarbazepine but be aware of the risk
of exacerbating myoclonic or absence seizures.
Adjunctive treatment: offer clobazam, lamotrigine, levetiracetam, sodium valproate or
topiramate if first-line treatments are ineffective or not tolerated.
If there are absence or myoclonic seizures, or if JME is suspected, do not offer
carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or
vigabatrin.

Absence seizures

First-line treatment: offer ethosuximide or sodium valproate as first-line treatment to

children, young people and adults with absence seizures. If there is a high risk of GTC
seizures, offer sodium valproate first, unless it is unsuitable. Offer lamotrigine if
ethosuximide and sodium valproate are unsuitable, ineffective or not tolerated.
Adjunctive treatment: if two first-line AEDs are ineffective, consider a combination of
two of these three AEDs as adjunctive treatment: ethosuximide, lamotrigine or sodium
valproate.
If adjunctive treatment is ineffective or not tolerated, discuss with, or refer to, a tertiary
epilepsy specialist and consider clobazam, clonazepam, levetiracetam, topiramate or
zonisamide.
Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin,
tiagabine or vigabatrin.

Myoclonic seizures

First-line treatment: offer sodium valproate as first-line treatment, unless it is unsuitable.

Consider levetiracetam or topiramate if sodium valproate is unsuitable or not tolerated.
Topiramate has a less favourable side-effect profile than levetiracetam and sodium
valproate.
Adjunctive treatment: offer levetiracetam, sodium valproate or topiramate if first-line
treatments are ineffective or not tolerated.
If adjunctive treatment is ineffective or not tolerated, discuss with, or refer to, a tertiary
epilepsy specialist and consider clobazam, clonazepam, piracetam or zonisamide.
Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin,
tiagabine or vigabatrin.
Tonic or atonic seizures

First-line treatment: offer sodium valproate as first-line treatment.

Adjunctive treatment: offer lamotrigine as adjunctive treatment if first-line treatment
with sodium valproate is ineffective or not tolerated.
Discuss with a tertiary epilepsy specialist if adjunctive treatment is ineffective or not
tolerated. Other AEDs that may be considered by the tertiary epilepsy specialist are
rufinamide and topiramate.
Do not offer carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or
vigabatrin.

Idiopathic generalised epilepsy (IGE)

First-line treatment: offer sodium valproate as first-line treatment, particularly if there is

a photo-paroxysmal response on EEG. Offer lamotrigine if sodium valproate is
unsuitable or not tolerated. Lamotrigine can exacerbate myoclonic seizures. Consider
topiramate but it has a less favourable side-effect profile than sodium valproate and
lamotrigine.
Adjunctive treatment: offer lamotrigine, levetiracetam, sodium valproate or topiramate
as adjunctive if first-line treatments are ineffective or not tolerated.
If adjunctive treatment is ineffective or not tolerated, discuss with, or refer to, a tertiary
epilepsy specialist and consider clobazam, clonazepam or zonisamide.
Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin,
tiagabine or vigabatrin.

Epilepsy with generalised tonic-clonic (GTC) seizures only

First-line treatment: offer lamotrigine or sodium valproate as first-line treatment. If they

have suspected myoclonic seizures, or are suspected of having JME, offer sodium
valproate first, unless it is unsuitable. Consider carbamazepine and oxcarbazepine but be
aware of the risk of exacerbating myoclonic or absence seizures.
Adjunctive treatment: offer clobazam, lamotrigine, levetiracetam, sodium valproate or
topiramate as adjunctive treatment if first-line treatments are ineffective or not tolerated.

Childhood absence epilepsy, juvenile absence epilepsy or other absence epilepsy

syndromes

First-line treatment: offer ethosuximide or sodium valproate as first-line treatment. If

there is a high risk of GTC seizures, offer sodium valproate first, unless it is unsuitable.
Offer lamotrigine if ethosuximide and sodium valproate are unsuitable, ineffective or not
tolerated.
Adjunctive treatment: if two first-line AEDs are ineffective or not tolerated, consider a
combination of two of ethosuximide, lamotrigine or sodium valproate.
 If adjunctive treatment is ineffective or not tolerated, discuss with, or refer to, a tertiary
epilepsy specialist and consider clobazam, clonazepam, levetiracetam, topiramate or
zonisamide.
Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin,
tiagabine or vigabatrin

REFERENCE:
Micromedex.com