Antiepileptic drug therapy for adults: when to initiate and how to choose


Antiepileptic drug therapy for adults: when to initiate and how to choose


Sirven JI



Mayo Clinic Proceedings




Humans; Adult; Treatment Outcome; Risk Factors; Amines; Cyclohexanecarboxylic Acids; gamma-Aminobutyric Acid; Non-U.S. Gov't; Research Support; Recurrence; Epilepsy/drug therapy; Carbamazepine/analogs & derivatives/therapeutic use; Fructose/analogs & derivatives/therapeutic use; Acetic Acids/adverse effects/therapeutic use; Anticonvulsants/adverse effects/therapeutic use; Isoxazoles/therapeutic use; Nipecotic Acids/therapeutic use; Piracetam/analogs & derivatives/therapeutic use; Propylene Glycols/adverse effects/therapeutic use; Triazines/adverse effects/therapeutic use


Although antiepileptic drugs (AEDs) are commonly used to control and prevent seizures, their long-term use carries a considerable risk of morbidity. The decision to start AEDs is made once the risks of further seizures outweigh the risks of treatment. Despite a large body of literature on the subject, this common clinical issue perplexes many practitioners because of its neurologic, psychological, and, at times, legal implications. Adding to the confusion is the recent approval of several new AEDs. This article summarizes the current evidence to support individual clinical decisions regarding initiation of AEDs in adults and considers the use of AEDs as seizure prophylaxis. Recently approved AEDs are discussed to help the practitioner understand when to initiate and how to choose the appropriate AED for the patient with seizures.


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Sirven JI, “Antiepileptic drug therapy for adults: when to initiate and how to choose,” Pediatric Palliative Care Library, accessed September 30, 2023,