Abstract

INTRODUCTION

The prevalence of treated epilepsy in the UK is about 80 per 100 000 people (Wallace et al. 1998). Antiepileptic drugs (AEDs) produce remission of seizures in 60–70% of people with epilepsy (Kwan & Brodie 2000) but many withdraw from AEDs because of lack of efficacy, an adverse effect, or both (Mattson et al. 1985; Marson 1997). The Holy Grail of epilepsy, an AED that is 100% effective but has no adverse effects or drug interactions, remains elusive. So how should we choose which AED to give first and, if that fails, which should be tried next? Choice of the first AED is crucial as many patients remain on that drug for many years (Lhatoo et al. 2001). This article is not intended as some foolproof ‘neurological recipe’, but rather as a guide based on current evidence, however imperfect, and the experience of success and failure over many