Background: The principles of epilepsy management are accurate diagnosis coupled with education, lifestyle advice, and drug therapy. There are a large number of anti-epileptic drugs now available.
Objective: This article deals with initial treatment, the role of the newer agents, and practical issues such as monitoring of therapy and the use of generic drugs. The difficult issues of when to stop therapy and management of epilepsy in pregnancy are highlighted.
Discussion: Accurate seizure and syndrome diagnosis determines the optimal choice of medication. In most patients with new onset epilepsy, seizures can be easily controlled with lifestyle modification and medication. In general, valproate is first line treatment for generalised epilepsy and carbamazepine for partial epilepsies. New anti-epileptic drugs offer benefits in patients who are not controlled or intolerant of the older agents. Monitoring of therapy is primarily clinical; not necessarily requiring testing for serum levels or other blood tests.