The main aim of treatment is to prevent the occurrence of seizures by using an effective dose of an antiepileptic drug (AED). Monotherapy of low doses of AEDs are used initially, with the dose adjusted until seizures are controlled. A single drug should be used to control epilepsy wherever possible. If this is not successful, monotherapy with another AED will be tried, but combination therapy with two or more AEDs may be needed. Caution is required when changing AEDs, with the slow withdrawal of the first drug only when the new regimen has been established.

A recent large multicentre trial has suggested that sodium valproate should be the drug of choice in generalised and unclassifiable types of epilepsy, and lamotrigine in focal types of epilepsy.

NICE goals of treatment

The NICE goals of treatment are to:

• Diagnose an individual by referral to a specialist after a first seizure
• Prescribe drug treatment following specialist assessment to stop or reduce seizure frequency and severity
• Monitor and review regularly, minimising effects of seizures on daily life
• Provide adequate and appropriate information to people with epilepsy.