IV. DRUG CHOICE

Choice of drug treatment is based on the classification of the seizures, patient-specific variables (for example, age, comorbid medical conditions, lifestyle, and personal preference), and characteristics of the drug (such as cost and interactions with other medications). In newly diagnosed patients, monotherapy is instituted with a single agent until seizures are controlled or toxicity occurs. Compared to those receiving combination therapy, patients receiving monotherapy exhibit better adherence and fewer side effects. If seizures are not controlled with the first drug, monotherapy with an alternate antiepileptic drug or drugs should be considered. Failing that, consider vagal nerve stimulation.