Treatment of Focal Epilepsy

General Principles of Treatment

• The American Academy of Neurology recommends that monotherapy should always be the initial approach for focal epilepsy, attempting to achieve seizure control with a single drug before considering combinations 1, 2
• The International League Against Epilepsy suggests that carbamazepina is a preferred option for adults and children with focal seizures 1, 2

First-Line Drugs for Monotherapy

• The National Institute for Health and Care Excellence recommends carbamazepina as a first-line treatment option for focal epilepsy 1, 2

Combination Therapy for Refractory Focal Epilepsy

• The American Epilepsy Society recommends that combination therapy with carbamazepina or lamotrigina and levetiracetam may be considered for patients with refractory focal epilepsy 1

Special Considerations

• The American College of Obstetricians and Gynecologists recommends that valproate should be avoided in women of childbearing potential whenever possible 1
• The American Academy of Neurology suggests that women of childbearing potential should be treated with lamotrigina or levetiracetam as first-line therapy, and combination therapy with valproate should be avoided 1

Treatment Algorithm

• The International League Against Epilepsy recommends starting with monotherapy (carbamazepina or lamotrigina for focal seizures) and considering combination therapy if monotherapy fails 1, 2

Warnings and Precautions

• The National Institute for Health and Care Excellence warns that unnecessary polytherapy increases the risk of adverse effects without additional benefit 1
• The American Academy of Neurology recommends considering withdrawal of antiepileptic medication after 2 years without seizures, evaluating clinical, social, and personal factors 1