Choice of Medications to Treat Seizures
Type | Medications | Use |
|---|---|---|
Generalized-onset tonic-clonic seizures | Divalproex Valproate | First-line monotherapy |
Lamotrigine Levetiracetam Topiramate | Second-line monotherapy or adjunctive therapy | |
Lacosamide Perampanel Zonisamide | Adjunctive therapy | |
Phenobarbital | 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 | Carbamazepine Fosphenytoin Lamotrigine Levetiracetam Oxcarbazepine Phenytoin Topiramate | First-line monotherapy |
Cenobamate Divalproex Eslicarbazepine Gabapentin Lacosamide Perampanel Pregabalin Valproate Zonisamide | Second-line monotherapy or adjunctive therapy | |
Clobazam Felbamate Tiagabine Vigabatrin | Third-line monotherapy or adjunctive therapy | |
Phenobarbital | Although effective, often considered less desirable because it is sedating and can cause behavioral problems in children | |
Typical nonmotor (absence) seizures | Divalproex Ethosuximide Lamotrigine Valproate | First-line monotherapy |
Clobazam Levetiracetam Topiramate Zonisamide | Also effective as second-line or adjunctive therapy | |
Atypical nonmotor (absence) seizures Nonmotor (absence) seizures associated with other seizure types | Divalproex Felbamate Lamotrigine Topiramate Valproate | First-line monotherapy |
Clonazepam | Also effective, but often development of tolerance | |
Acetazolamide | Reserved for refractory cases | |
Epileptic (infantile) spasms Atonic seizures Myoclonic seizures | Divalproex Valproate | First-line monotherapy |
Vigabatrin | Risk of irreversible visual field defects | |
Clonazepam | Second-line therapy | |
Dravet syndrome* | Valproate (or divalproex) Clobazam Topiramate Zonisamide | First-line therapies |
Cannabidiol (oral solution) Stiripentol with clobazam Fenfluramine | Adjunctive therapies | |
Tonic and/or atonic seizures in Lennox-Gastaut syndrome | Divalproex Lamotrigine Topiramate Valproate | First-line monotherapy |
Cannabidiol Fenfluramine | Adjunctive therapy | |
Clobazam Felbamate Zonisamide | Sometimes alternative or adjunctive therapy for atonic seizures | |
Juvenile myoclonic epilepsy | Divalproex Valproate | First-line monotherapy |
Lamotrigine† Levetiracetam Topiramate Zonisamide | Second-line monotherapy or adjunctive therapy | |
Unclassifiable seizures | Divalproex Valproate | First-line monotherapy |
Lamotrigine | Second-line monotherapy | |
Levetiracetam Topiramate Zonisamide | Third-line monotherapy or adjunctive therapy | |
Status epilepticus | Lorazepam Midazolam Diazepam | Initial treatment: A benzodiazepine administered intravenously A longer-acting second-line therapy is then added (see below) |
Fosphenytoin Phenytoin Levetiracetam Valproate Lacosamide | Second-line therapies | |
* 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. | ||