What can you tell us about the initial selection of an anti-seizure medication?

In this video, Professor Dr. Jacqueline French reviews practical, first-line decision-making for anti-seizure medication selection. She emphasizes aiming for a “forever drug” from the start to avoid later destabilization, and aligning treatment with the patient’s clinical profile and priorities. Key considerations include safety in women of child-bearing age, likelihood of weight change, dosing simplicity, and neuropsychiatric tolerability. Levetiracetam, while a common first-line treatment due to its convenience, can present mood-related adverse effects in a substantial subset of patients. Pre-existing neuropsychiatric issues may steer clinicians toward alternatives unless there are compelling reasons otherwise.

Jacqueline French, MD, NYU Langone Health’s Comprehensive Epilepsy Center