By seizure type
Primary generalized tonic-clonic (GTC) seizures
| Initial and first-line therapy |
Second-line or adjunctive therapy |
|---|
| carbamazepine |
phenobarbital |
| phenytoin |
primidone |
| valproate |
|
Partial seizures (with or without secondary generalization)
| Initial and first-line therapy |
Second-line or adjunctive therapy |
|---|
| carbamazepine |
felbamate* |
| phenytoin |
gabapentin |
| valproate |
lamotrigine |
| |
phenobarbital |
| |
primidone |
Absence seizures
| Initial and first-line therapy |
Second-line or adjunctive therapy |
|---|
| ethosuximide |
|
| valproate |
|
Myoclonic seizures
| Initial and first-line therapy |
Second-line or adjunctive therapy |
|---|
| valproate |
clonazepam |
Mixed seizures (myoclonic and tonic-clonic)
| Initial and first-line therapy |
Second-line or adjunctive therapy |
|---|
| felbamate* |
phenytoin |
| valproate |
primidone |
* Felbamate (Felbatol) is recommended for use only for patients who respond inadequately to alternative treatments and whose epilepsy is so severe that its benefits are deemed to outweigh a substantial risk of aplastic anemia, liver failure, or both.
Adapted from: Schachter SC. Treatment of seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 61-74. With permission from Elsevier (www.elsevier.com).
