title: Pharmacotherapy for tonic-clonic seizures.
abstract: BACKGROUND
  Occurrence of generalized tonic-clonic seizures (GTCS) is one of the most important risk factors of seizure-related complications and comorbidities in patients with epilepsy. Their prevention is therefore an important aspect of therapeutic management both in idiopathic generalized epilepsies and in focal epilepsies.
  
  
  METHODS
  It has been shown that the efficacy of antiepileptic drugs (AEDs) varies across epilepsy syndromes, with some AEDs efficacious against focal seizures with secondary GTCS (sGTCS) but aggravating primary GTCS (pGTCS). In patients with pGTCS, evidence-based data support the preferential use of valproic acid, lamotrigine, levetiracetam and topiramate. In patients with sGTCS, all AEDs approved in the treatment of focal epilepsies might be used.
  
  
  CONCLUSIONS
  Both in pGTCS and sGTCS, additional data are required, specifically to inform about the relative efficacy of AEDs in relation to each other. Although valproic acid might be the most efficacious drug in idiopathic generalized epilepsies, it should be avoided in women of childbearing age due to its safety profile. In patients with sGTCS, AEDs for which the impact on this seizure type has been formally evaluated and which have demonstrated greater efficacy than placebo might preferentially be used, such as lacosamide, perampanel and topiramate.
authors.affiliation: Hospices Civils de Lyon and CRNL, INSERM U1028, CNRS 5292 , Unité 301, Hôpital Neurologique, 59 Bd Pinel, 69003, Lyon , France sylvain.rheims@chu-lyon.fr.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rheims
authors.forename: Philippe
authors.initials: P
authors.lastname: Ryvlin
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D004829:Epilepsy, Generalized / Q000188:drug therapy*; D004830:Epilepsy, Tonic-Clonic / Q000188:drug therapy; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D000078334:Lacosamide; D000077213:Lamotrigine; D000077287:Levetiracetam; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy*; D000077236:Topiramate; D017211:Treatment Failure; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D000077287:Levetiracetam; D000078334:Lacosamide; D014635:Valproic Acid; D000077213:Lamotrigine; D010889:Piracetam
keywords: antiepileptic drugs; focal epilepsy; primary generalized epilepsy; tonic–clonic seizures