A patient with newly diagnosed temporal lobe epilepsy

The VA cooperative trials measured successful treatment as both reduction in seizure number and medication tolerability. Recent trials of new AEDs have focused more on responder rates and seizure number. However, for patients, side effects and seizures both impact on quality of life. Initial considerations of effective treatment must therefore incorporate both seizure freedom and tolerability into the treatment algorithm. At present, we lack the comparative trials needed to determine the relative efficacy of many of the newer AEDs. However, in the patient with readily controlled seizures, the AED side-effect profile, particularly the cognitive profile, is equally important as relative efficacy. In the young patient in this case study, who had new-onset partial seizures without secondary generalization, carbamazepine, lamotrigine, levetiracetam, and oxcarbazepine would all be desirable initial monotherapy. Other, less preferable, alternatives include phenytoin, gabapentin, and valproate. Even if the newer AEDs are found to be no more effective than the older agents, there is a likelihood that most will be better tolerated.