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Table 3. Drugs of first and second choice in the treatment of various seizure types and epilepsy

syndromes, and drugs to avoid in view of risk of exacerbation of seizures. (Adapted from
NICE12) CBZ carbamazepine; CLB clobazam; CLN clonazepam; ESM ethosuximide; GBP gabapentin; LEV

levetiracetam; LTG lamotrigine; OXC oxcarbazepine; PHT phenytoin; VPA sodium valproate; TGB tiagabine; TPM
topiramate; VGB vigabatrin

Seizure First line Adjunctive AEDs Do not offer
type/syndrome (may worsen
CBZ, LTG, OXC, CLB, GBP, LEV, seizures)
Focal seizures TPM, VPA PHT, TGB
ESM, LTG, VPA ESM, LTG, VPA CBZ, GBP,
Generalised seizures OXC, PHT,
Absence PGB, TGB,
VGB
GTC CBZ, LTG, OXC CLB, LTG, LEV, (if absence or
VPA, VPA, TPM myoclonic
seizures) CBZ,
GBP, OXC,
PHT, PGB,
TGB, VGB

Myoclonic LEV, VPA, TPM LEV, LTG, VPA CBZ, GBP,
OXC, PHT,
PGB, TGB,
VGB

Tonic or VPA LTG CBZ, GBP,
atonic OXC, PHT,
PGB, TGB,
Childhood absence ESM, LTG, VPA ESM, LTG, VPA VGB
epilepsy or other
absence syndromes ESM, LTG, VPA ESM, LTG, VPA CBZ, GBP,
OXC, PHT,
Juvenile absence LTG, LEV, VPA, LTG, LEV, VPA, PGB, TGB,
epilepsy or other TPM TPM VGB
absence epilepsy
syndromes CBZ, GBP,
Juvenile myoclonic OXC, PHT,
epilepsy PGB, TGB,
VGB
Genetic generalised LTG, VPA, TPM LTG, LEV, VPA,
epilepsy TPM CBZ, GBP,
OXC, PHT,
PGB, TGB,
VGB

CBZ, GBP,
OXC, PHT,
PGB, TGB,
VGB

BECTS CBZ, LTG, LEV, CBZ, CLB, GBP,
OXC, VPA LTG, LEV, OXC,
VPA, TPM