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).

Authored By: 
Steven C. Schachter MD
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