title: Antiepileptic drug therapy for adults: when to initiate and how to choose.
abstract: 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.
authors.affiliation: Department of Neurology, Mayo Clinic, Scottsdale, Ariz, USA.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Sirven
mesh_terms: D000085:Acetates / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000588:Amines; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002220:Carbamazepine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids; D004827:Epilepsy / Q000188:drug therapy*; D000078328:Felbamate; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D000077213:Lamotrigine; D000077287:Levetiracetam; D009557:Nipecotic Acids / Q000627:therapeutic use; D000078330:Oxcarbazepine; D048448:Phenylcarbamates; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011409:Propylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D000078308:Tiagabine; D000077236:Topiramate; D016896:Treatment Outcome; D014227:Triazines / Q000009:adverse effects / Q000627:therapeutic use; D000078305:Zonisamide; D005680:gamma-Aminobutyric Acid
chemical_list: D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D007555:Isoxazoles; D009557:Nipecotic Acids; D048448:Phenylcarbamates; D011409:Propylene Glycols; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D000077287:Levetiracetam; D000078305:Zonisamide; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000077213:Lamotrigine; D000078330:Oxcarbazepine; D000078328:Felbamate; D000078308:Tiagabine; D010889:Piracetam