Choice of Medications to Treat Seizures
Type | Medications | Use |
|---|---|---|
Generalized-onset tonic-clonic seizures | Divalproex Valproate | First-line monotherapy |
LamotrigineLamotrigine LevetiracetamLevetiracetam TopiramateTopiramate | Second-line monotherapy or adjunctive therapy | |
LacosamideLacosamide PerampanelPerampanel ZonisamideZonisamide | Adjunctive therapy | |
PhenobarbitalPhenobarbital | Although effective, often considered second-line monotherapy because it is sedating and can cause behavioral and learning problems in children | |
Various types of focal-onset and focal-to-bilateral tonic-clonic seizures | CarbamazepineCarbamazepine FosphenytoinFosphenytoin LamotrigineLamotrigine LevetiracetamLevetiracetam OxcarbazepineOxcarbazepine PhenytoinPhenytoin TopiramateTopiramate | First-line monotherapy |
CenobamateCenobamate Divalproex EslicarbazepineEslicarbazepine GabapentinGabapentin LacosamideLacosamide PerampanelPerampanel PregabalinPregabalin Valproate ZonisamideZonisamide | Second-line monotherapy or adjunctive therapy | |
ClobazamClobazam FelbamateFelbamate TiagabineTiagabine VigabatrinVigabatrin | Third-line monotherapy or adjunctive therapy | |
PhenobarbitalPhenobarbital | Although effective, often considered less desirable because it is sedating and can cause behavioral problems in children | |
Typical nonmotor (absence) seizures | Divalproex EthosuximideEthosuximide LamotrigineLamotrigine Valproate | First-line monotherapy |
ClobazamClobazam LevetiracetamLevetiracetam TopiramateTopiramate ZonisamideZonisamide | Also effective | |
Atypical nonmotor (absence) seizures Nonmotor seizures associated with other seizure types | Divalproex FelbamateFelbamate LamotrigineLamotrigine TopiramateTopiramate Valproate | First-line monotherapy |
ClonazepamClonazepam | Also effective, but often development of tolerance | |
AcetazolamideAcetazolamide | Reserved for refractory cases | |
Epileptic (infantile) spasms Atonic seizures Myoclonic seizures | Divalproex Valproate | First-line monotherapy |
VigabatrinVigabatrin | Risk of irreversible visual field defects | |
ClonazepamClonazepam | Second-line | |
Dravet syndrome* | CannabidiolCannabidiol ClobazamClobazam TopiramateTopiramate Valproate | Adjunctive therapy. |
Tonic and/or atonic seizures in Lennox-Gastaut syndrome | Divalproex LamotrigineLamotrigine TopiramateTopiramate Valproate | First-line monotherapy |
CannabidiolCannabidiol | Adjunctive therapy | |
ClobazamClobazam FelbamateFelbamate ZonisamideZonisamide | Sometimes alternative or adjunctive therapy for atonic seizures | |
Juvenile myoclonic epilepsy | Divalproex Valproate | First-line monotherapy |
Lamotrigine†Lamotrigine† LevetiracetamLevetiracetam TopiramateTopiramate ZonisamideZonisamide | Second-line monotherapy or adjunctive therapy | |
Unclassifiable seizures | Divalproex Valproate | First-line monotherapy |
LamotrigineLamotrigine | Second-line monotherapy | |
LevetiracetamLevetiracetam TopiramateTopiramate ZonisamideZonisamide | Third-line monotherapy or adjunctive therapy | |
Status epilepticus | FosphenytoinFosphenytoin PhenytoinPhenytoin LevetiracetamLevetiracetam Valproate | After initial lorazepamAfter initial lorazepam |
Note: Ezogabine has been withdrawn from the market because of limited use; the medication had a boxed warning for retinal abnormalities and potential vision loss. | ||
* Carbamazepine, phenytoin, and lamotrigine can worsen myoclonus and exacerbate seizures in patients with Dravet syndrome.* Carbamazepine, phenytoin, and lamotrigine can worsen myoclonus and exacerbate seizures in patients with Dravet syndrome. | ||
† Lamotrigine can aggravate myoclonic seizures in some patients with juvenile myoclonic epilepsy.† Lamotrigine can aggravate myoclonic seizures in some patients with juvenile myoclonic epilepsy. | ||