Principles of drug treatment in adults.

Abstract Treatment decisions have far-reaching consequences for patients with epilepsy. This chapter will discuss strategic decisions at different stages of the pharmacological treatment. Each decision needs to be based on a careful individual risk–benefit evaluation of the available options. The overall objective is to ensure the best possible quality of life according to the patient's individual circumstances. The pharmacological treatment of epilepsy aims at suppressing seizure activity to reduce, or when possible eliminate, the risk of further seizures in people with susceptibility to recurrent seizures. It is initiated when the expected benefits outweigh the drawbacks, and generally after at least two unprovoked seizures. Selection of the most appropriate drug for the patient is based on seizure type and epilepsy classification. However, age, gender, additional disabilities, or comorbidities as well as comedication need to be taken into account. When possible, the selected drug is slowly titrated to a low initial target dose and its effectiveness evaluated clinically. The dose is then adjusted according to the clinical response, although therapeutic drug monitoring may also be helpful in dosage individualization. Further issues discussed in this chapter are strategies when the first monotherapy fails and when and how treatment should be withdrawn in seizure-free patients.